II. Preparations: Hydrogen Peroxide

  1. Low Concentrations
    1. Small amount ingestions of low concentration Hydrogen Peroxide is unlikely to be toxic
      1. However, large ingestions of even this dilute solution can cause both caustic and embolic effects
    2. Household Hydrogen Peroxide (3-6%)
    3. Beauty Product Hydrogen Peroxide for bleaching hair and teeth (10%)
  2. High Concentrations (toxic)
    1. Food grade Hydrogen Peroxide (35%)
      1. Used for many fad uses without scientific basis (food, home remedy)
    2. Industrial Hydrogen Peroxide for whitening paper, cloth (>35%)

III. Adverse Effects

  1. Caustic Effects
    1. Oxidative, irritative and caustic effects results in local tissue injury
    2. Oropharyngeal burns and edema with risk of airway compromise
    3. Gastrointestinal burns and inflammation with risk of gastrointestinal perforation
  2. Air Embolism
    1. Catalase enzyme breaks down Hydrogen Peroxide to water and oxygen
    2. Every 1 ml of 35% Hydrogen Peroxide releases 100 ml oxygen when exposed to catalase
    3. If the oxygen bubbles that form in venous system cross to arterial circulation they embolize
      1. Pulmonary Embolism
      2. Cerebrovascular Accident
      3. Portal System gas

IV. Symptoms

  1. Gastrointestinal
    1. Vomiting
    2. Gastrointestinal erosions
  2. Cardiopulmonary
    1. Gas Embolism
    2. Myocardial Infarction
    3. Hypotension
    4. Lung Injury
  3. Renal
    1. Metabolic Acidosis
  4. Neurologic
    1. Seizures
    2. Cerebrovascular Accident

V. Imaging

  1. Consider specific imaging based on symptoms (e.g. CXR, KUB, CT, Brain imaging)

VI. Management

  1. See Toxin Ingestion
  2. See Caustic Ingestion
  3. See ABC Management
  4. Keep patient supine or in trendelenburg if portal gas is suspected
  5. Evaluate for airway compromise
  6. Asymptomatic dilute Hydrogen Peroxide Ingestions may be observed at home
  7. Consult Gastroenterology for caustic gastrointestinal effects
    1. Upper Endoscopy
  8. Consult toxicology or poison control
    1. Hyperbaric oxygen may be indicated in neurologic changes

VII. References

  1. Nordt in Herbert (2021) EM:Rap 21(1): 10-1
  2. Tomaszewski (2023) Crit Dec Emerg Med 37(4): 32

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