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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Ontology: Hydrogen Peroxide (C0020281)

Definition (NCI_NCI-GLOSS) A chemical used in bleaches, dyes, cleansers, antiseptics, and disinfectants. In a concentrated form, it is toxic and irritating to tissues.
Definition (MSH) A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials.
Definition (CSP) strong oxidizing agent and disinfectant, H2O2, used in aqueous solution as a bleach and topical anti-infective.
Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197) , Indicator, Reagent, or Diagnostic Aid (T130)
MSH D006861
SnomedCT 333301006, 273956008, 331301001, 31231007, 387171003
English Hydrogen Peroxide, Hydroperoxide, Peroxide, Hydrogen, Hydrogen Peroxide (H2O2), Hydrogen peroxide (H2O2), Hydrogen peroxide [mouth], Hydrogen peroxide [skin], Peroxide D'hydrogene, Peroxyde D'hydrogene, HYDROGEN PEROXIDE @ @ EACH, HYDROGEN PEROXIDE EACH, hydrogen peroxide (otic) (medication), otic preparations hydrogen peroxide, hydrogen peroxide (otic), HYDROGEN PEROXIDE, Hydrogen Peroxide [Chemical/Ingredient], hydrogen peroxide, hydrogen peroxide (medication), Hydrogen peroxide [skin] (product), Hydrogen peroxide [mouth] (product), Hydrogen peroxide, H2O2 - Hydrogen peroxide, Hydrogen dioxide, Hydrogen peroxide product, Hydrogen peroxide (product), Hydrogen peroxide (substance), Hydrogen peroxide [mouth] (substance), Hydrogen peroxide [skin] (substance), H2O2
French Peroxyde d'hydrogène, Eau oxygénée
Swedish Väteperoxid
Czech peroxid vodíku
Finnish Vetyperoksidi
Italian Idroperossido, Perossido d'idrogeno
Japanese 過酸化水素
Polish Nadtlenek wodoru
Norwegian Hydrogenperoksid, Hydroperoksid, Hydrogenperoksid (H2O2)
Spanish peróxido de hidrógeno (uso bucal) (producto), peróxido de hidrógeno (uso bucal), peróxido de hidrógeno (uso dermatológico) (producto), peróxido de hidrógeno (uso dermatológico), dióxido de hidrógeno, hidroperóxido, peróxido de hidrógeno (bucal) (producto), peróxido de hidrógeno (bucal), peróxido de hidrógeno (piel) (producto), peróxido de hidrógeno (piel), peróxido de hidrógeno (producto), peróxido de hidrógeno (sustancia), peróxido de hidrógeno, Peróxido de Hidrógeno
German Wasserstoffperoxid, Wasserstoffsuperoxid
Portuguese Peróxido de Hidrogênio

Ontology: Poisoning by hydrogen peroxide (C2959664)

Concepts Injury or Poisoning (T037)
SnomedCT 446337009
English Poisoning by hydrogen peroxide (disorder), Poisoning by hydrogen peroxide
Spanish intoxicación por peróxido de hidrógeno (trastorno), intoxicación por peróxido de hidrógeno