Hyperbaric oxygen for gas emboli following hydrogen peroxide ingestion

February 26, 2014, 10:08 pm

Early ad for hydrogen peroxide

Early ad for hydrogen peroxide

★★★☆☆

Hyperbaric Oxygen Therapy For Systemic Gas Embolism After Hydrogen Peroxide Ingestion. Byrne B et al. J Emerg Med 2014 Feb;46:171-175.

Abstract

Concentrated hydrogen peroxide (> 10%) is caustic and directly injures gastrointestinal mucosa after ingestion. In addition, when it contacts tissue catalase it releases large amounts of oxygen (1 ml of 35% hydrogen peroxide will produce 100 ml of oxygen.) This can result in gas embolism to the coronary or cerebral arteries, or the portal vein.

This case series describes 2 cases of case embolism after ingestion of concentrated hydrogen peroxide:

  • Patient A, a 53-year-old woman, ingested 10 drops of 35% hydrogen peroxide as a “cleanse”. She presented to the emergency department with nausea, vomiting, and abdominal pain. Abdominal CT showed gas emboli in the portal vein. Her symptoms resolved completely after 4 hours of hyperbaric oxygen (HBO) therapy.
  • Patient B, a 56-year-old male, inadvertently ingested almost 90 ml of hydrogen peroxide. He presented with nausea and vomiting, as well as facial paresthesias and left leg weakness. Head CT showed multiple air emboli in the cerebral arteries. His symptoms resolved after HBO therapy.

There is not anything new here. Although the use of HBO to treat gas emboli after hydrogen peroxide ingestion has not been studied in a randomized control trial — and obviously never will be — numerous case reports suggest that it is effective.

Some take-home lessons mentioned in the “Discussion” section of the paper:

  1. As little as “one sip” (1-5 ml) of hydrogen peroxide can cause problems.
  2. Imaging and endoscopy are appropriate for patients who have ingested solutions > 10% and those who have “significant symptoms.” including persistent abdominal pain, neurologic deficits, or hematemesis.
  3. HBO should be considered in patients with gas emboli after ingestion of hydrogen peroxide.

The paper is possibly most valuable for its 2 tables, that summarize reported cases of hydrogen peroxide ingestions treated with and without HBO.

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