Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 16, 2013
Hydrogen Peroxide Toxicity
- Ingestion of high concentrations of hydrogen peroxide (H2O2) can result in cerebral air embolism.
- Onset of symptoms and imaging abnormalities does not develop at the time of ingestion; rather, gas formation and subsequent embolism may take several days.
- Hydrogen peroxide decomposes via an exothermal reaction into water and oxygen. Oxygen gas bubbles generated after H2O2 ingestion diffuse into the venous circulation and pass directly into the arterial circulation via a patent foramen ovale, pulmonary arteriovenous fistula, or transpulmonary transportation over the pulmonary capillary bed.
- Key Diagnostic Features: MR diffusion and FLAIR images demonstrate multiple foci of cerebral ischemia, predominately in a cortical distribution. Air emboli can be directly visualized on Doppler ultrasound or CT scan.
- DDx: Embolism from any source, including valvular, cardiac, or vascular etiology
- Rx: Early hyperbaric oxygen therapy can result in complete neurologic recovery.
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