II. Preparations: Hydrogen Peroxide

  1. Low Concentrations (unlikely to be toxic)
    1. Household Hydrogen Peroxide (3-6%)
    2. 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. Oropharyngeal burns and edema with risk of airway compromise
    2. 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. Management

  1. See Toxin Ingestion
  2. See Caustic Ingestion
  3. See ABC Management
  4. Evaluate for airway compromise
  5. Consult Gastroenterology for caustic gastrointestinal effects
    1. Upper Endoscopy
  6. Consult toxicology or poison control
    1. Hyperbaric oxygen may be indicated in neurologic changes

V. References

  1. Nordt in Herbert (2021) EM:Rap 21(1): 10-1

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