Morning Report

Morning Report: Hydrogen Peroxide

Resident Presenter: Kimberly Citarrella PGY III

Topic: hyponatremia; intoxication

Case Summary: 32 yo Hispanic male w/ PMH EtOH abuse presents as AMS. Per brother, he went on a 1 week drinking binge and may have consumed H2O2. He has been vomiting, last vomitus with some blood. Patient is combative and requiring 4 point restraints. Diaphoretic, tachycardic, hypertensive, 5/5 strength all extremities, no obvious neuro deficits. ABG significant for Na 109 and K 2.26. Other labs: lactic acid 18.7; EtOH 80; WBC 21.7; CK 2841; serum osm 263; QTc 529. ICU, renal, ID consulted. 2% saline started. CK increased to > 3200 and Na increased slowly. He remained combative in the ICU. No intracranial process or infectious processes found.

Learning Points:

  • Most common adverse event is gas embolism (cerebral, cardiac) or portal vein thrombosis
  • Other worrisome adverse events is gastritis with hemorrhage, permanent neurologic impairment, and portal venous emboli.
  • Toxic effects are by direct cytotoxic effects and gas formation.

EBM Article:

Indorato, F., Raffino, C., Tropea, F.M. et al. Fatal accidental ingestion of 35 % hydrogen peroxide by a 2-year-old female: case report and literature review. Forensic Sci Med Pathol (2014) 10: 443. doi:10.1007/s12024-014-9560-9
https://rd.springer.com/article/10.1007%2Fs12024-014-9560-9

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