Presentation scenario:
(1) child or mentally impaired person with an empty bottle of hydrogen peroxide
(2) following an enema with hydrogen peroxide
(3) following a wound irrigation with hydrogen peroxide
(4) accidental swallowing of oral solution
(5) suicide attempt
(6) industrial exposure to a concentrated solution
A small volume of >= 10% hydrogen peroxide can cause injury. A large volume (>= 4 ounces) of a more dilute solution can cause problems in children.
Clinical findings:
(1) foaming or bubbling in the mouth or wound
(2) subcutaneous emphysema or other signs of oxygen release
(3) embolic phenomenon
(4) caustic signs and symptoms
(5) cardiopulmonary arrest, cyanosis, seizures, coma or other life-threatening condition
Screening for alternative explanations are negative:
(1) no other evidence for other toxic agents
(2) no evidence of sepsis or fulminant infection
The molecular weight of hydrogen peroxide is 34 grams. The solution is formulated in grams per 100 mL.
grams of hydrogen peroxide =
= (volume of solution in mL) * (percent from 0 to 100) /100
Hydrogen peroxide is lost from a solution if the bottle is not tightly sealed or stored improperly. The amount of hydrogen peroxide in an exposure may be less than that calculated based on the original strength.
