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Hydrogen peroxide (H2O2) is a common household liquid that is used for wound irrigation/antiseptic and cosmetic purposes. The concentration of household product is 3% to 5% and is considered to be relatively safe except in large volume ingestion.
High-concentration H2O2 (>10%) is commercially available as “food grade” (35%) that is diluted for household use or for alternative medicine therapy (i.e. hyperoxygenation).
Ingestion of high-concentration of H2O2 can result in caustic injury as well as ischemic injury from gas embolism.
Ingestion of 1 mL of 3% H2O2 produces 10 mL of O2 gas while 1 mL of 35% H2O2 produces 115 mL of O2 gas.
Common symptoms/findings of H2O2 ingestions includes:
- Nausea/vomiting
- Abdominal pain due to gas in portal venous system
- Caustic injury of GI track (ingestion of > 10% H2O2)
- Arterialization of O2 gas result in end-organ injury (e.g. CVA)
A retrospective review of >10% H2O2 ingestion from National Poison Data System showed:
- 13.9% developed gas embolic event
- 6.8% experienced permanent disability, including 5 deaths.
Management
- Minor symptoms: primary supportive
- CT ABD/Pelvis should be considerd if abdominal pain is present
- If significant gas is present in portal vein or evidence of end-organ injury (i.e. CVA), HBO therapy is recommended (limited evidence).
- Endoscopy should be considered in concentrated H2O2 ingestion to evaluate for caustic injury.
References
Hatten BW et al. Outcomes after high-concentration peroxide ingestions. Ann Emerg Med. 2017;69:726-736.