Cerebral air gas embolism from concentrated hydrogen peroxide ingestion

Abstract

Ingestion of even a small amount of concentrated hydrogen peroxide can result in cerebral air gas embolism. Hyperbaric oxygen therapy may be of benefit in reversing the symptoms and preventing permanent neurological impairment.

Massive Cerebral Gas Embolism under Discectomy due to Hydrogen Peroxide Irrigation

“…Gas embolism is a potentially catastrophe, though uncommon, event which occurs as the consequence of gas entry into the vasculature [ 1 ]. Hydrogen peroxide is typically benign with mucosal toxicity being the most commonly reported sign [ 2 ]. Direct exposure to hydrogen peroxide may cause cardiorespiratory insufficiency, shock, convulsions, coma, and chemical burns of skin and mucous membranes [ 3 ].…”

Hydrogen peroxide poisoning: an unusual cause of portal venous gas

“…Upon contact with the enzyme catalase in the gastric mucosa, H 2 O 2 undergoes rapid decomposition into oxygen and water (2H 2 O 2 → 2H 2 O + O 2 + heat). 4 If the amount of oxygen liberated exceeds the maximum solubility of blood, bubbles migrate through the epithelial interstices and gas embolism may occur, manifesting as pneumatosis 3 or gas within the portal venous system, 5 brain 6 and coronary arteries. 7 Toxicity is also caused by direct caustic injury to the gastric mucosa, resulting in gastritis and potential rupture, as well as cytotoxicity from lipid peroxidation.…”

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

“…3,[9][10][11] Three adult cases had complete resolution after HBO. Mullins 9 appears to be the first author to publish such a case.…”

“…It has been suggested that first-line treatment of acute arterial oxygen embolism following H 2 O 2 exposure is hyperbaric oxygen (HBO). 3 There are no standard guidelines about when to perform diagnostic imaging looking for venous embolism nor is there consensus as to which diagnostic modality should be utilized [i.e., plain films vs. noncontrast computerized tomography (CT)]. Furthermore, there is currently no consensus about what the standard treatment should be if acute venous oxygen embolism is found following H 2 O 2 exposure.…”