Treatment of Zinc Sulphide Poisoning
There is no specific antidote for zinc sulphide poisoning; treatment is entirely supportive with aggressive airway management, hemodynamic support, and correction of critical vital sign abnormalities as the immediate priority. 1, 2
Immediate Actions and Safety Precautions
Healthcare Worker Protection
- Ensure adequate ventilation of the treatment area immediately to prevent accumulation of toxic gases (hydrogen sulfide from zinc sulphide, similar to phosphine concerns with zinc phosphide) and secondary exposure to staff 2
- Use appropriate personal protective equipment including organic vapor filters for air-purifying respirators when managing these patients 2
- Avoid direct contact with emesis and gastric contents without proper protection to minimize risk of secondary toxic gas exposure to medical personnel 2
Contact Poison Control
- Call your regional poison center immediately (1-800-222-1222 in the United States) for expert toxicology guidance, as zinc compound poisonings require specialized management 1, 2
Supportive Care (Primary Treatment)
Airway and Breathing
- Provide immediate airway management and support of breathing as the first priority 1, 3
- Consider supplemental oxygen for patients with respiratory distress 4
- Prepare for intubation if the patient has CNS depression, severe respiratory compromise, or inability to protect airway 1
Hemodynamic Support
- Treat hypotension with fluid boluses (10-20 mL/kg normal saline) 5
- For refractory hypotension, consider vasopressors (norepinephrine or epinephrine preferred over dopamine) 5
- Monitor for and treat dysrhythmias according to advanced cardiac life support protocols 5
Metabolic Derangements
- Correct critical vital sign and metabolic abnormalities promptly 1, 3
- Monitor for signs of cellular hypoxia and multisystem organ dysfunction 6
Decontamination Strategy
What NOT to Do
- Do not induce vomiting - this may worsen the clinical condition and cause aspiration 2
- Do not administer activated charcoal or syrup of ipecac for zinc compound ingestion 2
- Do not administer anything by mouth unless specifically advised by poison control 2
Potential Decontamination Options
- Consider polyethylene glycol for whole bowel irrigation if radiopaque material is visible on abdominal X-ray and the patient presents early 2
- This decision should be made in consultation with poison control 1
Seizure and Agitation Management
- Administer benzodiazepines (diazepam or midazolam) for severe agitation or seizures if they occur 3, 5
Advanced Therapies (Case-by-Case Basis)
- Extracorporeal membrane oxygenation (ECMO) may be required for cardiovascular support in severe cases 1, 7
- Hemoperfusion has been used in some zinc poisoning cases for enhanced elimination 4
- Chelating agents may be considered for zinc toxicity, though evidence is limited for acute zinc sulphide poisoning specifically 7, 8
- Bronchoalveolar lavage if inhalation exposure is suspected 4
Common Pitfalls to Avoid
- Do not delay supportive care while waiting for identification of the specific poison or toxicology results 3
- Do not assume single agent exposure - consider multiple ingestions with intentional exposures or suicide attempts 8
- Do not underestimate the need for intensive monitoring - zinc compound poisonings can cause delayed multisystem organ dysfunction 6