What is Hydrogen Peroxide Toxicity?
Hydrogen peroxide is a chemical that naturally exists in our bodies because of the process our cells use to produce energy. It is also used for different purposes in our homes and industries, such as bleaching, cleaning, and disinfecting. The concentration of hydrogen peroxide typically ranges between 3 to 9% in household use, most commonly 3%. In industrial use, it can have a concentration as high as 70%, usually between 27.5 and 70%.
Many people use hydrogen peroxide at home for removing ear wax, as a mouthwash, for cleaning surfaces or fabric, and for bleaching hair. Medical professionals also use it as a disinfectant and cleansing fluid during patient care and in operating rooms. Some health food shops sell higher concentrations of hydrogen peroxide as a type of “hyperoxygenation therapy” claiming that it’s a safe and effective treatment for many conditions, including cancer and mental illness. However, there’s no scientific evidence supporting these claims, and such use of hydrogen peroxide has led to serious harm and even death.
As a disinfectant, hydrogen peroxide works quickly by forming highly reactive particles called free radicals. These free radicals can damage various cellular components, including proteins, DNA, and cell membrane lipids – not only in bacteria/viruses but also in the cells of the body. Use of hydrogen peroxide can be harmful if it comes into contact with the skin or eyes, is swallowed, used to clean wounds or rectum, injected, or inhaled. The degree of harm can depend on the concentration of the solution and the method of exposure.
What Causes Hydrogen Peroxide Toxicity?
Hydrogen peroxide is usually a mild irritant when it comes into contact with skin. When it comes into contact with your wet skin or lining of your body parts, like the mouth or eyes, it can cause more noticeable discomfort. It might cause a stinging sensation, but usually, it’s not severe. If it gets into your eyes, it can be very painful and may hurt the cornea (clear front surface of the eye) or the conjunctiva (thin layer that covers the front of the eye).
If you accidentally swallow diluted hydrogen peroxide, you could experience mild symptoms like damaged mouth lining, stomach ache, and feelings of nausea and vomit. This happens because when hydrogen peroxide meets tissues in your body, it reacts and releases oxygen gas.
However, stronger concentrations of hydrogen peroxide, often used in industry, can cause much more severe damage. They’re known as corrosive substances and can lead to serious chemical burns. If swallowed, they can burn your mouth, throat, and esophagus. The reaction with tissues in your body also releases a lot of oxygen gas.
The gas can also enter your bloodstream because hydrogen peroxide can cross easily from your stomach into nearby blood vessels. If it goes straight into your blood, it releases oxygen gas and could potentially cause harmful air bubbles in your blood vessels, including in your brain.
Inhalation of hydrogen peroxide can also be harmful. It can cause damage to the tissues and irritate your airways, making it harder for you to breathe. Lastly, very concentrated hydrogen peroxide can be harmful to your cells due to a process called lipid peroxidation, which basically means it can attack the fats in your cell membranes and damage them.
Risk Factors and Frequency for Hydrogen Peroxide Toxicity
Hydrogen peroxide poisoning is a problem that tends to occur in two groups: young children and adults. It’s not uncommon for children to get exposed to this kind of poisoning, but this is usually accidental and involves normal household concentrations of hydrogen peroxide.
Adults, on the other hand, run into bigger risks. They may ingest large quantities of hydrogen peroxide on purpose, or come into contact with more concentrated sources in workplaces. Unfortunately, this poisoning can be more serious in adults. Although children’s exposure is usually from lower concentration solutions and less harmful types of exposure, their smaller size means it takes a lower volume to cause toxicity.
Signs and Symptoms of Hydrogen Peroxide Toxicity
Exposure to hydrogen peroxide can result in different symptoms depending on how a person comes into contact with it. Mild symptoms might be seen from topical exposure to a diluted solution, often clearing up quickly with cleaning efforts. More concentrated topical exposures can lead to serious skin burns, typically seen in adult workers in industries like paper and fabric manufacturing, foam rubber, and rocket fuel.
People who get hydrogen peroxide in their eyes may experience watering eyes, redness, pain, and possible vision loss, which could be either temporary or permanent.
Young children who accidentally swallow hydrogen peroxide will mostly experience nausea and vomiting. If a large quantity is ingested, one may have changes in mental function, as the chemical can enter the bloodstream and cause air bubbles in the blood vessels.
Adults who intentionally ingest hydrogen peroxide, usually consuming higher concentrations or bigger amounts, often come to the hospital late, demonstrating severe symptoms such as:
- Gaseous distention
- Abdominal pain
- Nausea and vomiting
- Changes in mental function
- Neurological shifts
- Low blood pressure
These scenarios can also lead to gastrointestinal bleeding due to the damage to the stomach lining, tissue death or rupture from rapid stomach expansion. It often requires a thorough examination involving a tube passed down the throat to visualize the tract for proper management.
Hydrogen peroxide introduced directly into the bloodstream, such as from aggressively rinsing wounds, accidentally injecting it into veins, or irrigating surgical wounds, can cause symptoms like air bubbles in blood vessels, local gas production, pain, swelling, and possible skin damage.
One rare way of exposure is when it comes into contact with mucous membranes during procedures like enemas or washings during surgery. This could also happen in the nose or mouth from inhalation injuries, ingestions, or gargling. Inhalation may affect breathing and could lead to severe breathing difficulties. Patients may come in with symptoms of wheezing, drooling, and/or stridor (a high-pitched, wheezing sound caused by disrupted airflow) and may show signs of narrowing in the part of the airway below the vocal cords on x-ray images.
Testing for Hydrogen Peroxide Toxicity
When a patient comes in after being exposed to a harmful substance, it’s important that the doctor knows key details about the exposure. For something like hydrogen peroxide, your doctor will want to know about the concentration of the substance, how you were exposed to it and where on your body the exposure occurred. This information helps the doctor know what tests to run and what to look for. Your doctor will also ask about any symptoms you might be experiencing, like nausea, vomiting, difficulty breathing, or pain. It’s important to tell your doctor when you were exposed and if you might have been exposed to any other harmful substances.
Next, the doctor will physically examine you. This usually starts with a close look at the site of exposure for any visible signs of injury, such as redness, white discoloration or even mouth ulcers. The doctor will also check for any signs that your airway might be affected, like abnormal breathing sounds or swelling in your throat or nose. They’ll also look for evidence of gas formation, like swollen skin or a bloated abdomen. The examination also includes a thorough check of your neurological health, as there is a risk of air bubbles entering the bloodstream.
Although there’s no specific test for hydrogen peroxide exposure, your doctor may order blood tests to check for complications. This could include a complete blood count, particularly if there’s severe vomiting of blood, and tests to check for signs of a heart attack. The doctor should also consider the possibility of additional toxic exposures.
If there is concern for pockets of air in the bloodstream, or ‘air embolism’, imaging tests should be performed. The test used will focus on the area of concern. For any changes in brain function, CT or MRI scans of the head or spine might be necessary. If there’s worry about air in the heart or air pockets elsewhere, chest imaging through either X-ray or CT scans could be performed. Your doctor might also order imaging of the abdomen or pelvis if there are concerns about air in the digestive tract or possible air emboli in other areas.
Treatment Options for Hydrogen Peroxide Toxicity
Hydrogen peroxide treatments depend a lot on how much and what concentration you have been exposed to. Unfortunately, there isn’t a direct cure for hydrogen peroxide poisoning and methods like dialysis—where an artificial kidney machine removes waste and excess toxins from your blood—don’t work. If you’ve only taken in a small amount of weak hydrogen peroxide, you’re unlikely to have severe symptoms and can probably watch out for symptoms safely at home. But, if you ingest a larger amount, you might experience significant symptoms and have to visit the emergency room. That said, even in these cases, treatment typically involves managing the symptoms.
A method healthcare providers may use is a nasogastric tube which is a thin tube that is threaded through your nose into your stomach to remove any remaining hydrogen peroxide. This might be a suitable option if you reach the hospital soon enough after ingestion. It can also help relieve some symptoms like nausea by decompressing, or relieving pressure from, your gastrointestinal, or digestive, tract. Often, people who’ve ingested hydrogen peroxide feel nauseous or throw up a lot, and these episodes may make their vomit frothy.
If you’ve been exposed to hydrogen peroxide by it coming into contact with your skin, healthcare providers will initially aim to clean the area. Step one would involve taking off any clothing that may have gotten soaked with the chemical. Then, the area is thoroughly washed with a lot of water or a sterile saline solution — which is a mixture of salt and water. In case the exposure happened in the eyes, a healthcare provider would remove any contact lenses and rinse the eyes thoroughly with a saline solution. To check for any injuries to the cornea, which is the transparent front part of the eye, they might use fluorescent dye and a device called a slit lamp. If there are any injuries, further treatment will be needed and a follow-up appointment with an ophthalmologist—a doctor who specializes in eye and vision care—is recommended.
For exposures involving more concentrated hydrogen peroxide, the steps are the same, starting with cleaning the area where it made contact. However, in these cases, you might experience more severe symptoms and may require additional treatment. If the healthcare provider is worried that your airways might be blocked due to tissue damage, they might have to put a tube in your airway immediately as the tissue damage can worsen quickly.
Patients who show signs of air bubbles in their blood vessels—which is technically called air emboli—should receive a specific type of scan quickly. If any air is found in the area between the lungs or in the heart, or the patient has abnormally low blood pressure due to air emboli, the patient might have to be positioned lying down with the head lower than the rest of the body. This position helps prevent air bubbles from blocking the flow of blood.
In some cases, a treatment called hyperbaric therapy—which involves breathing pure oxygen in a pressurized room or tube—might be considered. This is usually for patients with symptoms related to air emboli. If the situation is very severe, patients might need a central line placement. This is a tube that’s placed into a large vein in your neck, chest, or groin to give medications or draw blood and it might be used to remove air from major blood vessels or the right side of the heart.
What else can Hydrogen Peroxide Toxicity be?
The kind of medical conditions that a doctor has to consider in their diagnosis can depend on how a patient has been exposed to harm. If the damage is from swallowing something insignificant, a patient may have symptoms that include a stomach ache, feeling sick to the stomach, and throwing up. This can look like a stomach bug, pancreatitis, poisoning from something else, or other usual causes for an upset stomach.
In cases where the injury comes from inhaling something harmful, a patient might show signs that range from minor to severe breathing difficulty. This could look similar to an episode of severe asthma, other types of injuries from inhaling something harmful, respiratory infections, or severe allergic reactions.
Vicious exposure or direct intake into the bloodstream from an injection or forceful washing of the wound might show up with altered mental status, coma, lack of enough oxygen in the body, and low blood pressure. The medical conditions that the doctor has to consider can be broad if there’s no other history is available. Thankfully, the evaluation for patients showing these intense symptoms will very likely include an image screening or lab test that can lead to the diagnosis of poisoning by hydrogen peroxide, assuming that the physician is aware of the dangers and display of such exposures.
What to expect with Hydrogen Peroxide Toxicity
The outcome of exposure to any substance largely depends on the type of exposure and how concentrated the substance is. For instance, exposure to a substance through your skin or eyes is likely to have a good outcome, regardless of the concentration. However, if the solution is highly concentrated, it might result in chemical burns. The recovery from these burns depends on how deep the injury is, where it is on the body, and how much skin is involved. There can be complications like increased risk of death or disease if the injury is on a large surface area or involves a joint. If the eyes are involved, there’s a possibility of corneal scarring.
Inhaling harmful substances usually causes mild symptoms, but in severe cases, early treatment is necessary. If you only have mild symptoms, there’s a good chance of recovery. Even with severe symptoms, the outlook is generally good if you receive prompt medical attention. However, prolonged exposure might lead to chronic lung diseases.
How harmful a substance is when swallowed varies greatly based on the concentration and the amount ingested. If you swallow a small amount of a low-concentration solution, the prognosis is extremely good, and you can usually be monitored at home safely. However, swallowing large amounts of a diluted solution or small amounts of a concentrated one can be very dangerous, especially if it causes an air embolism (air bubbles in the bloodstream). Concentrated solutions can even be deadly in certain situations. For example, a 2-year-old boy sadly lost his life after accidentally swallowing around 120 to 180 milliliters of 35% hydrogen peroxide, which caused air in the chest cavity and heart.
Another fatal incident involved a 2-year-old girl who accidentally took “2 sips” of 35% hydrogen peroxide while visiting a dairy farm. An autopsy showed extensive damage to her air sacs in the lungs, erosion of the windpipe, and bloating of the lining of her digestive and respiratory systems due to gas.
Possible Complications When Diagnosed with Hydrogen Peroxide Toxicity
If a person has a minor skin injury from a chemical, it will usually heal without any lasting damage. However, serious chemical burns need to be treated like any other serious burn. These severe burns can lead to scarring, dehydration from losing body fluids, and infections. Eye injuries from chemicals can cause serious burns and may result in temporary or long-term vision loss.
Swallowing chemicals can have serious consequences. It can cause damage and scarring to the food pipe or throat. This can result in the narrowing of these areas, which can cause difficulties in swallowing. If the ingested chemical, such as hydrogen peroxide, enters the bloodstream, it may cause tiny gas bubbles known as air emboli. These bubbles can lead to tissue death, resulting in a variety of outcomes depending on where they form. They could even cause permanent brain damage or can be fatal in some cases. There have been instances of air emboli in the brain leading to severe disabilities, similar to effects seen in stroke patients.
Common impacts and outcomes:
- Healing without any permanent damage for minor skin injuries
- Potential scarring, dehydration, and infections from severe chemical burns
- Temporary or long-term vision loss from eye injuries
- Scarring and narrowing of the food pipe or throat from swallowing chemicals
- Potential for air emboli if chemicals enter the bloodstream
- Permanent brain damage or fatal outcomes due to air emboli
- Severe disabilities, similar to stroke, due to brain emboli
Preventing Hydrogen Peroxide Toxicity
Generally, most substances are safe to use. However, there can be situations where even commonplace substances can be harmful. It is crucial for us to understand the risks associated with common household chemicals, like hydrogen peroxide. We should buy these products from trustworthy sources and in quantities that are appropriate for home use. Furthermore, it is always a good idea to consult with a healthcare professional before beginning any new medical treatments.
