A recent case report from a medical team in India describes rare yet life-threatening complications after a man accidentally drank from a bottle of hydrogen peroxide.
He had grabbed a bottle of what looked like water and swigged it back – hours later, he was in the emergency department with a life-threatening cerebral air gas embolism.
It turned out to have been highly concentrated hydrogen peroxide, reports MedPage Today.
The ingestion triggered a rare but potentially fatal neurologic emergency detailed in a case report by Tonie Selwin Arockiasamy, MD, of Christian Medical College and Hospital in Vellore, India, and colleagues published in BMJ Case Reports.
“It highlights the need for improved public awareness regarding the risks of high-concentration hydrogen peroxide, especially in occupational or household settings,” the authors wrote.
“Misidentification or accidental ingestion can lead to life-threatening complications, as seen in this patient.”
The report describes a man in his 50s who accidentally drank about 40ml of hydrogen peroxide at a concentration of 50%.
Exposures to hydrogen peroxide account for roughly 0.4% of cases handled by US poison centres and by the WebPoisonControl system, said Michael Chary, MD, PhD, co-director of WebPoisonControl, which is operated by the National Capital Poison Centre in Washington, and provides guidance to the public and clinicians about toxic exposures.
“For the generalist, it’s rare, and the most important thing is to recognise that this is a poisoning of some sort, and they should call a toxicologist,” Chary, who is also an emergency medicine physician at Weill Cornell Medicine in New York City, told MedPage Today.
“This stuff gets very, very intricate very quickly.”
Hydrogen peroxide is widely found in homes and workplaces, where it is used as a cleaner, wound disinfectant, tooth whitener and hair-bleaching agent.
At low concentrations – typically 3% to 6% – it is generally considered safe. At higher concentrations, ingestion can be dangerous or life-threatening.
“Above 10%, you’re going to have symptoms,” Chary said. “It doesn’t really matter if it’s a drop on the tongue or you gulp the whole thing. It’s going to be bad. Right out of the starting gate, irrespective of the volume, at 50% … it’s going to be bad no matter where (the patient) shows up.”
Highly concentrated hydrogen peroxide rapidly breaks down into water and oxygen, releasing large volumes of gas that can enter the bloodstream.
“That’s effectively what happened here. He got air in his blood vessels,” Chary said.
Immediately after ingestion, the patient experienced severe retrosternal burning and throat pain and was taken to a local hospital, where gastric lavage was performed before he was referred to Christian Medical College and Hospital.
Several hours later, he developed acute weakness in his left arm and leg, prompting concern for stroke. Brain imaging with MRI revealed multiple acute infarcts in different vascular territories, a pattern consistent with cerebral air embolism.
He was treated with high-concentration supplemental oxygen and supportive care. While the authors noted that hyperbaric oxygen therapy is the most effective treatment, they added that high-concentration oxygen remains the mainstay where hyperbaric facilities are unavailable.
Chary pointed out that the problem is not one of the concentration of oxygen.
“The issue is the size. Because it’s a physical blockage, you want to shrink the size so blood can get around the bubble.”
The man's neurologic status improved during the next few days. With continued supportive management and oxygen therapy, he was discharged after partial recovery of strength and function.
Because cerebral air embolism can progress rapidly and be fatal, early recognition is critical, the authors noted. Any patient who develops neurologic symptoms after ingesting concentrated hydrogen peroxide should undergo urgent neuroimaging and be treated as a medical emergency.
Chary warned that symptoms also may be delayed, and an initially mild presentation does not exclude the risk of catastrophic embolic complications hours later.
“This case highlights an uncommon yet life-threatening presentation and emphasises the need for timely diagnosis and intervention,” the authors wrote.
Study details
Hydrogen peroxide poisoning presenting as cerebral air gas embolism
Tonie Selwin Arockiasamy, Jonathan Aruljeevan Jayakaran, Ramya Iyadurai.
Published in BMJ Case Reports Volume 19
Abstract
We report a rare case of cerebral air embolism following ingestion of hydrogen peroxide, a chemical commonly found in household disinfectants and hair bleaching products. Although often perceived as benign, ingestion of concentrated hydrogen peroxide can cause mucosal injury and life-threatening systemic air embolism. Presentations may range from mild or no symptoms to acute, life-threatening neurological events, yet standardised treatment protocols are lacking. We describe a middle-aged gentleman who presented after accidentally ingesting hydrogen peroxide. He initially experienced retrosternal burning immediately after intake and developed acute weakness a few hours later. Neuroimaging revealed multiple cerebral infarcts caused by air emboli. He was treated with high-concentration oxygen therapy and supportive care, leading to clinical improvement. This case highlights the potential for severe neurological injury from hydrogen peroxide exposure and emphasises the importance of prompt diagnosis and brain imaging when cerebral air embolism is suspected.
BMJ Case Reports – Hydrogen peroxide poisoning presenting as cerebral air gas embolism (Open access)
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