Hydrogen peroxide ingestion associated with portal venous gas and treatment with hyperbaric oxygen: a case series and review of the literature.
BACKGROUND
Ingestion of concentrated hydrogen peroxide (H(2)O(2)) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H(2)O(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(2)O(2) exposure and HBO treatment. Cases were reviewed for the concentration of H(2)O(2), 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(2)O(2) was ingested and in 1 case 12% H(2)O(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(2)O(2) ingestions.
French
Loren Keith
LK
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA. frenchk@ohsu.edu
Horowitz
B Zane
BZ
McKeown
Nathanael J
NJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D004618:Embolism, Air / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000506:poisoning*; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein
D006861:Hydrogen Peroxide