Hydrogen peroxide ingestion associated with portal venousgas and treatment with hyperbaric oxygen: a case seriesand review of the literature

Abstract

Introduction. Ingestion of concentrated hydrogen peroxide (H₂O^₂) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H^₂O^₂ is generally considered a benign ingestion in low concentrations, case reports have described serious toxicity following high concentration exposures. Hyperbaric oxygen (HBO) has been used with success in managing patients suffering from gas embolism with and without manifestations of ischemia. Methods. Poison center records were searched from July 1999 to January 2010 for patients with H^₂O^₂ exposure and HBO treatment. Cases were reviewed for the concentration of H₂O₂, symptoms, CT scan findings of portal gas embolism, HBO treatment, and outcome. Results. Eleven cases of portal gas embolism were found. Ages ranged from 4 to 89 years. All but one ingestion was accidental in nature. In 10 cases 35% H^₂O^₂ was ingested and in 1 case 12% H^₂O^₂ was ingested. All abdominal CT scans demonstrated portal venous gas embolism in all cases. Hyperbaric treatment was successful in completely resolving all portal venous gas bubbles in nine patients (80%) and nearly resolving them in two others. Ten patients were able to be discharged home within 1 day, and one patient had a 3.5-day length of stay. Conclusions. HBO was successful in resolving portal venous gas embolism from accidental concentrated H^₂O^₂ ingestions.

Keywords:

• Hydrogen peroxide
• Portal venous gas
• Hyperbaric oxygen
• Embolic gas
• H₂O₂