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.
