title: Hyperbaric oxygen therapy for the prevention of arterial gas embolism in food grade hydrogen peroxide ingestion.
abstract: Food grade hydrogen peroxide ingestion is a relatively rare presentation to the emergency department. There are no defined guidelines at this time regarding the treatment of such exposures, and providers may not be familiar with the potential complications associated with high concentration hydrogen peroxide ingestions. In this case series, we describe four patients who consumed 35% hydrogen peroxide, presented to the emergency department, and were treated with hyperbaric oxygen therapy. Two of the four patients were critically ill requiring intubation. All four patients had evidence on CT or ultrasound of venous gas emboli and intubated patients were treated as if they had an arterial gas embolism since an exam could not be followed. After hyperbaric oxygen therapy each patient was discharged from the hospital neurologically intact with no other associated organ injuries related to vascular gas emboli. Hyperbaric oxygen therapy is an effective treatment for patients with vascular gas emboli after high concentration hydrogen peroxide ingestion. It is the treatment of choice for any impending, suspected, or diagnosed arterial gas embolism. Further research is needed to determine which patients with portal venous gas emboli should be treated with hyperbaric oxygen therapy.
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States. Electronic address: stephen.hendriksen@hcmed.org.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hendriksen
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Menth
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Bjorn C
authors.initials: BC
authors.lastname: Westgard
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Cole
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Walter
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Masters
authors.affiliation: Hennepin County Medical Center, 701 Park Ave, P1.661, Minneapolis, MN 55415, United States.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Logue
mesh_terms: D000059:Accidents; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004618:Embolism, Air / Q000139:chemically induced* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000506:poisoning*; D006931:Hyperbaric Oxygenation / Q000379:methods; D020766:Intracranial Embolism / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D011169:Portal Vein; D016896:Treatment Outcome
chemical_list: D006861:Hydrogen Peroxide
keywords: Arterial gas embolism; Hydrogen peroxide; Hyperbaric oxygen; Venous gas embolism