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Ingestion of food grade hydrogen peroxide with resultant gastrointestinal and neurologic symptoms treated with hyperbaric oxygen therapy: case report and review with emphasis on the therapeutic value of HBO2 in vascular gas embolism.
Pak, S, Valencia, D, Lee, C, Lach, J, Ortiz, G
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc. 2021;(2):177-186
Abstract
A 52-year-old male accidentally ingested approximately 100 mL of 35% hydrogen peroxide (H2O2), resulting in the sudden onset of gastrointestinal and neurologic symptoms. Non-contrast abdominal CT revealed extensive portal venous gas and gastric pneumatosis. The patient was treated with hyperbaric oxygen therapy which resulted in complete resolution of symptoms. The case highlights the therapeutic value of hyperbaric oxygen therapy in the treatment of vascular gas embolism and mitigation of concentrated H2O2 ingestion toxicity.
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Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review.
Panagopoulos, D, Antoniades, E, Karydakis, P, Giakoumettis, D, Themistocleous, M
The American journal of case reports. 2020;:e920213
Abstract
BACKGROUND Various factors have been implicated in the pathogenesis of infarction after posterior fossa surgery such as venous air embolism, patient's position (seated or prone), hyperflexion of the neck, excessive spinal cord traction, cervical canal stenosis, and systemic arterial hypotension. The main aim of this case report was to elucidate a case in which hydrogen peroxide was implicated in a major and systemic complication after a neurosurgical procedure. CASE REPORT We describe the case of a 5-year-old female patient who was admitted to our hospital because of a cerebellar hemispheric astrocytoma associated with obstructive hydrocephalus and accompanied by 2 syringomyelic cavities in the cervicothoracic portion of the spinal cord. Immediately after gross total resection of the lesion, impaired mobility of the upper and lower extremities was observed, a finding that was not consistent with intraoperative neurophysiologic monitoring data. Hydrogen peroxide had been judiciously used to irrigate the resection tumor cavity. In the next few postoperative days, the patient suffered from transient diabetes insipidus and hyperpyrexia, indicative of hypothalamic injury. CONCLUSIONS Neurological evaluation of the patient, after stabilization of her medical condition, revealed residual spasticity of upper and lower extremities, rendering her able to mobilize via the aid of wheelchair only. The most possible pathophysiologic explanation of her neurological deterioration, including hypothalamic dysfunction, was analyzed. The role of hydrogen peroxide as a source of free radical formation, and its co-responsibility for vascular platelet aggregation and vasoconstriction was considered, upon case review, the main responsible etiologic factor.
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3.
Oxygen Embolism and Pneumocephalus After Hydrogen Peroxide Application During Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Case Report and Literature Review.
Zou, P, Yang, JS, Wang, XF, Wei, JM, Guo, H, Zhang, B, Zhang, F, Chu, L, Hao, DJ, Zhao, YT
World neurosurgery. 2020;:201-204
Abstract
BACKGROUND Hydrogen peroxide (H2O2) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that H2O2 can result in toxicity to keratinocytes and fibroblasts, but complications after H2O2 application, including oxygen embolism, which is one of the most severe, have rarely been reported. CASE DESCRIPTION A 40-year-old woman was diagnosed with L4-5 lumbar spinal stenosis and subsequently underwent minimally invasive transforaminal lumbar interbody fusion treatment at another hospital. Hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occurred immediately after H2O2 irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography scan revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci. CONCLUSIONS When using a knee-prone surgical position or in cases of dural laceration, the application of undiluted H2O2 solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occur immediately after H2O2 irrigation, oxygen embolism should be strongly suspected.
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4.
Hydrogen peroxide in orthopaedic surgery - is it worth the risk?
Yang, Y, Reid, C, Nambiar, M, Penn, D
Acta chirurgica Belgica. 2016;(4):247-250
Abstract
Hydrogen peroxide (H2O2) is commonly used in orthopaedic surgery during cemented arthroplasty and wound washouts. Its purported roles include antisepsis, haemostasis, mechanical debridement, and optimising the cement-bone interface during cementing. However, despite its apparent harmless mechanism of action, H2O2 has been implicated in fatal and near fatal complications caused through oxygen emboli. We present a case of oxygen embolism and review the existing literature to highlight its potential risks and its lack of therapeutic value. We believe there is little role for its use in orthopaedic surgery.
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5.
Fatal accidental ingestion of 35 % hydrogen peroxide by a 2-year-old female: case report and literature review.
Indorato, F, Raffino, C, Tropea, FM, Barbera, N, Grieco, A, Bartoloni, G
Forensic science, medicine, and pathology. 2014;(3):443-7
Abstract
Deaths after ingestion of hydrogen peroxide (HP) are very rare, but poisoning due to consumption of HP is not uncommon. Most HP exposure involves common household-strength (3 %) HP and is usually benign. Even if it is not generally considered to be a poison, it can cause accidental death. HP results in morbidity through two main mechanisms: direct cytotoxic injury to tissues and formation of oxygen gas. We describe a rare case of a 2-year-old female who died after accidentally ingesting two sips of 35 % HP. For the first time, we provide histopathological images of the damage caused by HP in organic tissues.
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Treatment of portal venous gas embolism with hyperbaric oxygen after accidental ingestion of hydrogen peroxide: a case report and review of the literature.
Papafragkou, S, Gasparyan, A, Batista, R, Scott, P
The Journal of emergency medicine. 2012;(1):e21-3
Abstract
BACKGROUND It is well known that hydrogen peroxide ingestion can cause gas embolism. OBJECTIVE To report a case illustrating that the definitive, most effective treatment for gas embolism is hyperbaric oxygen therapy. CASE REPORT We present a case of a woman who presented to the Emergency Department with acute abdominal pain after an accidental ingestion of concentrated hydrogen peroxide. Complete recovery from her symptoms occurred quickly with hyperbaric oxygen therapy. CONCLUSION This is a case report of the successful use of hyperbaric oxygen therapy to treat portal venous gas embolism caused by hydrogen peroxide ingestion. Hyperbaric oxygen therapy can be considered for the treatment of symptomatic hydrogen peroxide ingestion.
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7.
Safety and effectiveness of a new enzyme-targeting radiosensitization treatment (KORTUC II) for intratumoral injection for low-LET radioresistant tumors.
Ogawa, Y, Kubota, K, Ue, H, Tadokoro, M, Matsui, R, Yamanishi, T, Hamada, N, Kariya, S, Nishioka, A, Nakajima, H, et al
International journal of oncology. 2011;(3):553-60
Abstract
Linear accelerator-based radiotherapy has little effect on tumors such as malignant melanoma, various types of sarcoma, and most locally-advanced neoplasms that have grown to several centimeters or more. These tumors contain many hypoxic cancer cells or large amounts of anti-oxidative enzymes, and are therefore resistant to low linear energy transfer radiation. Therefore, it was necessary to develop a new radiosensitizer to overcome these situations. We previously developed a new enzyme-targeting radiosensitization treatment named KORTUC I, which uses 3% w/v hydrogen peroxide solution-soaked gauze. We developed a new radiosensitizer for intratumoral injection (KORTUC II), comprising a combination of hydrogen peroxide and sodium hyaluronate. After providing a fully informed written consent, 52 patients with unresectable or recurrent neoplasms (53 lesions) were enrolled in the KORTUC II trial. The present study of 52 patients with unresectable or recurrent neoplasms showed that KORTUC II is safe when injected intratumorally, well tolerated, and can efficiently exert a radiation sensitizing effect. Because this radiosensitizer is safe and less expensive than other methods, and can be applied for almost every type of low-LET radio-resistant neoplasm, it has potential for worldwide and immediate use.
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8.
Hydrogen peroxide ingestion associated with portal venous gas and treatment with hyperbaric oxygen: a case series and review of the literature.
French, LK, Horowitz, BZ, McKeown, NJ
Clinical toxicology (Philadelphia, Pa.). 2010;(6):533-8
Abstract
INTRODUCTION Ingestion of concentrated hydrogen peroxide (H(2)O(2)) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H(2)O(2) is generally considered a benign ingestion in low concentrations, case reports have described serious toxicity following high concentration exposures. Hyperbaric oxygen (HBO) has been used with success in managing patients suffering from gas embolism with and without manifestations of ischemia. METHODS Poison center records were searched from July 1999 to January 2010 for patients with H(2)O(2) exposure and HBO treatment. Cases were reviewed for the concentration of H(2)O(2), symptoms, CT scan findings of portal gas embolism, HBO treatment, and outcome. RESULTS; Eleven cases of portal gas embolism were found. Ages ranged from 4 to 89 years. All but one ingestion was accidental in nature. In 10 cases 35% H(2)O(2) was ingested and in 1 case 12% H(2)O(2) was ingested. All abdominal CT scans demonstrated portal venous gas embolism in all cases. Hyperbaric treatment was successful in completely resolving all portal venous gas bubbles in nine patients (80%) and nearly resolving them in two others. Ten patients were able to be discharged home within 1 day, and one patient had a 3.5-day length of stay. CONCLUSIONS HBO was successful in resolving portal venous gas embolism from accidental concentrated H(2)O(2) ingestions.
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9.
[Can iatrogenic air embolism related to intraoperative use of hydrogen peroxide be easily avoided?].
Guitard, PG, Delmon, P, Acra, M, Lechevallier, J, Dureuil, B
Revue de chirurgie orthopedique et reparatrice de l'appareil moteur. 2007;(6):603-6
Abstract
Air embolism is a rare complication of intraoperative use of hydrogen peroxide. We present the case of a young girl who underwent surgery for septic nonunion of the femur and developed this complication postoperatively. Outcome was fortunately favorable. A review of the surgery and anesthesia literature revealed the pathogenic mechanism of this type of accident together with the appropriate diagnostic and therapeutic practices. We propose here a series of preventive measures based on our experience and data in the literature: inform the anesthetist before using hydrogen peroxide, use a cup instead of a syringe for administrating hydrogen peroxide and avoid use in deep highly vascularized cavities.
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10.
Waiting-list induced proctitis: the hydrogen peroxide enema.
Gan, SI, Price, LM
Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2003;(12):727-9
Abstract
Hydrogen peroxide is a widely available disinfectant that has been reported to cause colitis. We report a case of a 67-year-old man who presented with an acute proctitis caused by a self-inflicted 3% hydrogen peroxide enema. The patient's intention was to cure himself of a recently diagnosed prostate cancer, because the waiting list for oncological consultation was deemed too long. The pathogenesis of hydrogen peroxide mucosal injury and a review of the literature is discussed.