UMEM Educational Pearls

Category: Toxicology

Title: Hydrogen Peroxide

Keywords: hydrogen peroxide (PubMed Search)

Posted: 12/22/2011 by Fermin Barrueto, MD (Updated: 8/21/2019)
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Generally H2O2 is available OTC at a concentration of 3-9% and used as an antiseptic. Toxicity is by two methods: local irritation like a caustic and gas formation - both directly correlating with the % concentration. Some interesting findings have occurred with this ingestion including:

1) Portal vein gas seen on CT

2) Arterialization of O2 resulting in CVA

3) Encephalopathy with cortical visual impairment

4) MRI showing b/l hemispheric CVAs

Even use of 3% H2O2 for wound irrgation has caused subcutaneous emphysema and O2 emboli.

Treatment: XR/CT/MRI may detect gas, if present in RV should be placed in Tredelenburg and carefully aspirated through a central venous catheter. Anectdotal case reports have used HBO therapy when patients were critically ill.(1)

References

1) Mullins et al. Acute cerebral gas embolism from hydrogen peroxide ingestion successfully treated with HBO. J Toxicol Clin Toxicol 1998; 38: 111-112.