We report an usual case of strokes due to gas emboli following accidental ingestion of hydrogen  peroxide.

Hydrogen peroxide (H2O2)is used as a disinfectant or irrigation of wounds. This is also used as GI detox agent. H2O2 rapidly dissociate to form oxygen and water. One mL of 35% H2O2 liberates about 115mL of O2 gas. Upon accidental ingestion of H202, this O2 gas can enter in to systemic circulation either through direct entry through arterial system, paradoxically from venous system through intracardiac right -to left shunt or through retrograde cerebral venous gas embolism.

61 year old with past medical history of HTN,DM admitted to MICU with h/o accidental ingestion of  35% hydrogen peroxide while attempting GI cleanse. Patient confused between two bottles and thought she was drinking distilled water and gulped about 8 oz of H2O2.

 She started vomiting white foam immediately which was followed by bloody vomiting. Her mental status deteriorated rapidly requiring airway protection. She was subsequently found to have erosive esophagitis and pneumomediastinum.  HCT was done which showed bilateral  frontal hypodensity. On exam patient was drowsy and was not moving any extremities (grade zero power) but had intact brain stem reflexes. MRI of brain showed  extensive bilateral cerebral and cerebellar restricted diffusion, primarily in a cortical distribution, not conforming to any particular vascular territory, with sparing of the hippocampi, basal ganglia, and brainstem. She was treated conservatively for her erosive esophagitis and mediastinitis. She slowly regained consciousness but unfortunately she didn’t show much improvement in the power of her extremities and had global aphasia. She was discharged to  long term rehabilitation.

This case raises awareness of serious side effects of hydrogen peroxide causing fatal complications which warrants awareness among physicians and community so as to avoid morbidity and mortality.