Multiple Brain Gas Embolism After Ingestion of Concentrated Hydrogen Peroxide

Ijichi, Toshiharu; Itoh, Tsuyoshi; Sakai, Ryuta; Nakaji, Keisuke; Miyauchi, Takumi; Takahashi, Ryoichi; Kadosaka, Shozo; Hirata, Masahiro; Yoneda, Seiichi; Kajita, Yoshihiro; Fujita, Yoichi

doi:10.1212/wnl.48.1.277

Cited by 37 publications

(16 citation statements)

References 5 publications

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“…Our patient also showed signs of gastritis, with hematemesis, similar to other cases of CAGE (6,11). There have been three proposed mechanisms by which orally ingested hydrogen peroxide could produce an arterial gas embolism.…”

Section: Cage From H 2 O 2 817supporting

confidence: 83%

“…In all the patients receiving HBOT there was complete resolution of symptoms (7,9). In the 7 patients not undergoing HBOT: one died (4), four had persistent hemiparesis (4,6,8,11), one had spastic quadriplegia and seizures (4) and only in one case was there reported to be complete resolution of previous deficits: hemiparesis, and a six nerve palsy (5). Based on these reports, the relatively low risk involved in HBOT, and its established role as treated for CAGE from other causes (20): Physicians should consider HBOT as first line therapy in all cases of CAGE from concentrated hydrogen peroxide ingestion.…”

Section: Cage From H 2 O 2 817mentioning

confidence: 99%

“…Most exposures to peroxide are benign but toxic exposures occurring as a result of ingestion have been reported (3). A rare, but known, complication of concentrated hydrogen peroxide ingestion is cerebral artery gas embolism (CAGE) (4)(5)(6)(7)(8)(9). We report a patient who unintentionally ingested 33% hydrogen peroxide and presented with symptoms and magnetic resonance imaging (MRI) findings suggestive of multiple cerebral arterial gas emboli; and his subsequent response to treatment with hyperbaric oxygen therapy.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral air gas embolism from concentrated hydrogen peroxide ingestion

Rider

Jackson

Rusyniak

2008

Clinical Toxicology

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Section: Cage From H 2 O 2 817supporting

confidence: 83%

Section: Cage From H 2 O 2 817mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebral air gas embolism from concentrated hydrogen peroxide ingestion

Rider

Jackson

Rusyniak

2008

Clinical Toxicology

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“…The outcomes of accidental ingestion, or intentional ingestion for suicide, of solutions of 10% hydrogen peroxide and higher were more severe than those seen at lower concentrations (Dickson and Caravati, 1994). Accidental ingestion of 35% hydrogen peroxide has resulted in several fatal or near-fatal poisonings (Giusti, 1973;Giberson et al, 1989;Humberston et al, 1990;Christensen et al, 1992;Sherman et al, 1994;Litovitz et al, 1995;Ijichi et al, 1997). These individuals vomited, were cyanotic, and experienced convulsions and respiratory failure (Giberson et al, 1989).…”

Section: (V-6) Toxicity Of Hydrogen Peroxide and Carbamide Peroxide Cmentioning

confidence: 99%

Tooth Bleaching—a Critical Review of the Biological Aspects

Dahl

Pallesen

2003

Critical Reviews in Oral Biology & Medicine

469

370

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Present tooth-bleaching techniques are based upon hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% immediate success has been reported for intracoronal bleaching of non-vital teeth, and in the period of 1-8 years' observation time, from 10 to 40% of the initially successfully treated teeth needed re-treatment. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. When the external tooth-bleaching technique is used, the first subjective change in tooth color may be observed after 2-4 nights of tooth bleaching, and more than 90% satisfactory results have been reported. Tooth sensitivity is a common side-effect of external tooth bleaching observed in 15%-78% of the patients, but clinical studies addressing the risk of other adverse effects are lacking. Direct contact with hydrogen peroxide induced genotoxic effects in bacteria and cultured cells, whereas the effect was reduced or abolished in the presence of metabolizing enzymes. Several tumor-promoting studies, including the hamster cheek pouch model, indicated that hydrogen peroxide might act as a promoter. Multiple exposures of hydrogen peroxide have resulted in localized effects on the gastric mucosa, decreased food consumption, reduced weight gain, and blood chemistry changes in mice and rats. Our risk assessment revealed that a sufficient safety level was not reached in certain clinical situations of external tooth bleaching, such as bleaching one tooth arch with 35% carbamide peroxide, using several applications per day of 22% carbamide peroxide, and bleaching both arches simultaneously with 22% carbamide peroxide. The recommendation is to avoid using concentrations higher than 10% carbamide peroxide when one performs external bleaching. We advocate a selective use of external tooth bleaching based on high ethical standards and professional judgment.

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“…Cerebral gas embolism is known to occur in several clinical settings such as trauma, surgery, sudden air pressure changes, central venous catheter placement [3], mechanical ventilation [7], lung biopsy, angiography [11], ingestion of concentrated hydrogen peroxide [5], endoscopy, or with an oesophagealatrial fistula [10]. It can easily be diagnosed with CT, if the scan is performed shortly after symptom onset [3,4].…”

mentioning

confidence: 99%