Ingestion of 35% hydrogen peroxide

The ingestion of hydrogen peroxide is usually benign. However, the ingestion of greater than 10% hydrogen peroxide can result in significant pathology. Two fatalities are reported in the literature involving children who ingested 27% and 40%. We report a case involving the ingestion of one mouthful of 35% hydrogen peroxide by a 26-month-old female. The child vomited spontaneously. In the Emergency Department the child was lethargic and had an episode of bright red emesis. Several hours later the child experienced a fainting episode followed by a brief respiratory arrest after which she began drooling bright red blood. The initial oral evaluation was negative. Endoscopic evaluation performed 16 hours postingestion revealed erosion of the cardia of the stomach, erythema of the lower esophageal sphincter, and an additional gastric burn. The child was observed for six days and discharged. Follow-up endoscopy performed 12 days postingestion showed only minimal hyperemia in the cardia of the stomach. Exposures to concentrated hydrogen peroxide should be managed aggressively.