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Ann Emerg Med. Author manuscript; available in PMC 2015 Sep 1.
Published in final edited form as:
Edward P. Manning, Larissa K Laskowski, DO, Lewis S. Nelson, MD, and Michael Touger, MD
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The publisher's final edited version of this article is available at Ann Emerg Med
A 23-year-old woman presented to the emergency department with epigastric pain and vomiting after unintentionally ingesting a cleaning agent stored in her refrigerator. On physical examination, the patient was tachycardic at 100 beats/min, but was otherwise well-appearing with a soft, non-tender abdomen. Initial blood work was unremarkable. Computed tomography of the abdomen and pelvis (Figure 1) and upper endoscopy were performed (Figure 2).
Computed tomography of the abdomen and pelvis revealing gas in the stomach and hepatic portal veins.
Diagnosis
Ingestion of 35% hydrogen peroxide
Unlike dilute (3-9%) hydrogen peroxide sold for home use as a disinfectant and topical antiseptic, 35% hydrogen peroxide is used primarily for industrial purposes and for cleaning fruits and vegetables. It has also been promoted as an alternative health remedy, known as “hyperoxygenation therapy.” Although dilute hydrogen peroxide is a mild irritant, concentrated hydrogen peroxide is a caustic, causing necrosis and ulceration of mucosal tissue (1,2).
Assuming one mouthful equals 30 mL, such ingestion of 35% hydrogen peroxide could yield approximately 3,000 mL of oxygen gas. Following systemic absorption of hydrogen peroxide, metabolism by catalase in red blood cells liberates oxygen. If intact hydrogen peroxide bypasses the liver prior to metabolism, cerebral gas embolism may occur (3).
The patient was treated at the local hyperbaric treatment facility (3,4) with resolution of her abdominal pain. Her course was complicated by two bouts of coffee-ground emesis. Endoscopy revealed a Zargar 2A mucosal injury associated with diffuse erosion of the esophagus and stomach (Figure 2). The patient responded well to treatment with esomeprazole, ondansetron, and simethicone and was discharged on hospital day three.
Acknowledgments
Grant: EPM supported by MSTP Training Grant T32-GM007288
Footnotes
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Meetings: not previously presented
Conflicts of Interest: none reported
Contributor Information
Edward P. Manning, Albert Einstein College of Medicine and Department of Emergency Medicine, Jacobi Medical Center.
Larissa K Laskowski, Department of Emergency Medicine, New York University School of Medicine.
Lewis S. Nelson, Department of Emergency Medicine, New York University School of Medicine and New York City Poison Control Center.
Michael Touger, Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine.
References
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3. French LK, Horowitz BZ, McKeown NJ. Hydrogen Peroxide Ingestion Associated with Portal Venous Gas and Treatment with Hyperbaric Oxygen: a Case Series and Review of the LIterature. Clin Toxicol (Phila.) 2010;48:533–538. [PubMed] [Google Scholar]
4. U.S. Navy Diving Manual, Revision 6 with change A [Online] Commander, Naval Sea Systems Command; [accessed October 11, 2013]. Oct 15, 2011. Dive Table 6. http://www.supsalv.org/00c3_publications.asp. [Google Scholar]
