Abstract
Hydrogen peroxide is a well-known remedy used in homeopathic medicine. Accidental ingestion can have a broad range of side effects depending upon the quantity and concentration of ingestion. Air emboli to the brain have been reported in very few case reports. We present an interesting case of accidental ingestion of 35% hydrogen peroxide resulted in ischemic stroke and seizures due to air embolism. Our patient was an elderly woman who accidentally drank industrial strength hydrogen peroxide thinking of water. Upon ingestion of approximately two tablespoons of hydrogen peroxide, she developed respiratory distress within few minutes. She was reported to have a frothy mouth and soon became unresponsive. EMS arrived and intubated her on her way to the hospital. A CT of the chest/abdomen/pelvis showed air in the heart, spleen, splenic and portal veins. A CT, MRI of head and EEG were performed to evaluate her altered mental status. She was treated with phenytoin, midazolam for seizure prophylaxis and hyperbaric oxygen for the air embolism without improvement. The family ultimately decided to transition to comfort measures only. This is a rare case of air embolism. About 20% of air-embolism occurs in contrast enhanced CTâs. Very rarely it can be because of hydrogen peroxide poisoning. Hydrogen peroxide has many common uses but has a great potential for misuse. Hyperbaric oxygen has a role in both limiting damage and enhancing recovery. This is the current standard of care as documented in previously reported case.
Highlights
Hydrogen peroxide, an oxidizing agent, is used in several household products, including disinfectants, chlorine-free bleaches, fabric stain removers, contact lens disinfectants and hair dyes, and some tooth whitening products as well [1,2].Medicinal uses of Hydrogen peroxide include wound irrigation and sterilization of ophthalmic and endoscopic instruments [1,2]
We report a case in which an elderly woman presents with ischemic stroke due to air embolism after ingesting unlabeled 35% Hydrogen Peroxide
Severe complications are rare with 3-5% concentrated hydrogen peroxide, but ingestion can cause respiratory tract irritation, gastrointestinal mucosal damage, vomiting, and gastric distention [2]
Summary
An oxidizing agent, is used in several household products, including disinfectants, chlorine-free bleaches, fabric stain removers, contact lens disinfectants and hair dyes, and some tooth whitening products as well [1,2]. Medicinal uses of Hydrogen peroxide include wound irrigation and sterilization of ophthalmic and endoscopic instruments [1,2]. There are three primary mechanisms by which hydrogen peroxide causes toxicity, namely: corrosive damage, oxygen gas formation and lipid peroxidation [2]. While exposure results in local tissue damage by caustic action, ingestion of concentrated (>35%) hydrogen peroxide can lead to the generation of substantial volumes of oxygen. We report a case in which an elderly woman presents with ischemic stroke due to air embolism after ingesting unlabeled 35% Hydrogen Peroxide
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