II. Preparations: Hydrogen Peroxide
- Low Concentrations
- Small amount ingestions of low concentration Hydrogen Peroxide is unlikely to be toxic
- However, large ingestions of even this dilute solution can cause both caustic and embolic effects
- Household Hydrogen Peroxide (3-6%)
- Beauty Product Hydrogen Peroxide for bleaching hair and teeth (10%)
- Small amount ingestions of low concentration Hydrogen Peroxide is unlikely to be toxic
- High Concentrations (toxic)
- Food grade Hydrogen Peroxide (35%)
- Used for many fad uses without scientific basis (food, home remedy)
- Industrial Hydrogen Peroxide for whitening paper, cloth (>35%)
- Food grade Hydrogen Peroxide (35%)
III. Adverse Effects
- Caustic Effects
- Oxidative, irritative and caustic effects results in local tissue injury
- Oropharyngeal burns and edema with risk of airway compromise
- Gastrointestinal burns and inflammation with risk of gastrointestinal perforation
-
Air Embolism
- Catalase enzyme breaks down Hydrogen Peroxide to water and oxygen
- Every 1 ml of 35% Hydrogen Peroxide releases 100 ml oxygen when exposed to catalase
- If the oxygen bubbles that form in venous system cross to arterial circulation they embolize
IV. Symptoms
- Gastrointestinal
- Vomiting
- Gastrointestinal erosions
- Cardiopulmonary
- Renal
- Neurologic
V. Imaging
- Consider specific imaging based on symptoms (e.g. CXR, KUB, CT, Brain imaging)
VI. Management
- See Toxin Ingestion
- See Caustic Ingestion
- See ABC Management
- Keep patient supine or in trendelenburg if portal gas is suspected
- Evaluate for airway compromise
- Asymptomatic dilute Hydrogen Peroxide Ingestions may be observed at home
- Consult Gastroenterology for caustic gastrointestinal effects
- Upper Endoscopy
- Consult toxicology or poison control
- Hyperbaric oxygen may be indicated in neurologic changes
VII. References
- Nordt in Herbert (2021) EM:Rap 21(1): 10-1
- Tomaszewski (2023) Crit Dec Emerg Med 37(4): 32