Cerebral air gas embolism from concentrated hydrogen peroxide ingestion

Steven P. Rider, Sue B. Jackson, Daniel Rusyniak

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Introduction. Ingestion of a small amount of concentrated hydrogen peroxide can cause cerebral air gas embolism (CAGE). Hyperbaric oxygen therapy (HBOT) is the standard of care in the treatment of CAGE. We report a case of CAGE after accidental ingestion of 33% hydrogen peroxide treated with HBOT resulting in reversal of both the clinical and radiologic abnormalities. Case report. A 48 year-old male took two sips of 33% hydrogen peroxide. A short time later, he developed hematemesis, left sided hemiplegia, confusion, and left homonymous hemianopsia. Initial laboratory studies, chest x-ray, and brain CT were normal. MRI demonstrated areas of restricted diffusion and T2 hyperintensities in multiple vascular territories consistent with ischemia due to CAGE. Eighteen hours after arrival, the patient underwent HBOT at 3 atmospheres absolute (ATA) for 30 minutes and 2.5 ATA for 60 minutes with clinical improvement. Follow-up MRI at six months demonstrated resolution of the hyperintensities. Discussion. A search of MEDLINE from 1950 to present revealed only two cases of CAGE from ingestion of concentrated hydrogen peroxide treated with HBOT. Both cases, similar to ours, had complete resolution of symptoms. Of the seven reported cases of CAGE from hydrogen peroxide that did not undergo HBOT, only in one patient was there a report of symptom resolution. Conclusion. 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.

Original languageEnglish
Pages (from-to)815-818
Number of pages4
JournalClinical Toxicology
Volume46
Issue number9
DOIs
StatePublished - Nov 2008

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Air Embolism
Hydrogen Peroxide
Eating
Gases
Oxygen
Hyperbaric Oxygenation
Air
Magnetic resonance imaging
Atmosphere
Brain
Hemianopsia
Hematemesis
X rays
Hemiplegia
Standard of Care
MEDLINE

Keywords

  • Air gas embolism
  • Hydrogen peroxide
  • Hyperbaric oxygen therapy

ASJC Scopus subject areas

  • Toxicology

Cite this

Cerebral air gas embolism from concentrated hydrogen peroxide ingestion. / Rider, Steven P.; Jackson, Sue B.; Rusyniak, Daniel.

In: Clinical Toxicology, Vol. 46, No. 9, 11.2008, p. 815-818.

Research output: Contribution to journalArticle

Rider, Steven P. ; Jackson, Sue B. ; Rusyniak, Daniel. / Cerebral air gas embolism from concentrated hydrogen peroxide ingestion. In: Clinical Toxicology. 2008 ; Vol. 46, No. 9. pp. 815-818.
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