Hydrogen peroxide

CAS RN: 7722-84-1

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Treatment is symptomatic and supportive. Water can be administered to dilute the solution in the case of ingestion. Gastric distention may be relieved by insertion of a nasogastric tube and suction. A careful examination should be done to detect any gas formation. Ocular exposure to 3% solution usually requires only thorough irrigation.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Upper airway injury may require intubation. Patients may require resuscitation for burns. Endoscopy should be performed to assess gastrointestinal tract injury if the patient is symptomatic or if higher concentration ingestion is suspected. Obtain surgical consult for patients with evidence of gastrointestinal tract perforation. If the patient has significant symptoms of oxygen embolism (such as CNS effects), place the patient in Trendelenburg position and consider treatment with hyperbaric oxygen. Treat seizures with IV benzodiazepines or barbiturates. Ocular exposure to high concentrations warrants slit lamp examination and ophthalmologic consultation.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Do not induce vomiting or administer activated charcoal. Irrigate any dermal or ocular exposures with large volumes of water.
    • 2) HOSPITAL: Because hydrogen peroxide causes tissue injury rather than systemic toxicity, there is no role for activated charcoal. Insertion of a nasogastric tube to remove gastric contents and to decompress the stomach may be attempted following large ingestions.
  • D) AIRWAY MANAGEMENT
    • 1) Endotracheal intubation should be considered early for patients who have symptoms of upper airway obstruction.
  • E) ANTIDOTE
    • 1) None.
  • F) ENHANCED ELIMINATION
    • 1) Hemoperfusion, hemodialysis, and peritoneal dialysis are not effective and not recommended.
  • G) PATIENT DISPOSITION
    • 1) OBSERVATION CRITERIA: Most patients who have inadvertently ingested 3% hydrogen peroxide can be observed safely at home if not symptomatic.
    • 2) ADMISSION CRITERIA: Patients who may have ingested a large amount of lower concentration solution, or any amount of high concentration solution, or who are symptomatic should be evaluated with endoscopy and treated for significant gastrointestinal burns. Patients with evidence of oxygen emboli should be admitted to an intensive care setting.
    • 3) CONSULT CRITERIA: Consult a Poison Center for assistance in managing patients with severe toxicity or in whom the diagnosis is unclear. Obtain surgical consult as needed for patients with evidence of gastrointestinal tract perforation.
  • H) PITFALLS
    • 1) Failure to recognize that oxygen embolism may cause symptoms in many organ systems.
  • I) PHARMACOKINETICS
    • 1) Hydrogen peroxide is absorbed rapidly by the gastrointestinal tract.
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) Caustic injury may occur from ingestion of acid or alkaline products.
0.4.3 INHALATION EXPOSURE
  • A) Monitor for respiratory tract irritation and hypoxia after severe inhalation exposure.
0.4.4 EYE EXPOSURE
  • A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
  • B) Ocular exposure to HOUSEHOLD STRENGTH (3%) solutions usually requires little more than thorough irrigation, since serious complications are rare. However, ocular exposure to INDUSTRIAL STRENGTH (greater than 10%) solutions not only requires thorough irrigation, but given the possibility of corneal ulceration or perforation, evaluation in a healthcare facility is recommended.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
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