A 40 y.o. male was cleaning an industrial tank of hydrogen peroxide. He became thirsty and took a swallow out of a bottle he assumed had water.

The water bottle had been full of oxywave 26.5 % hydrogen peroxide, peroxyactic acid. Poison control told him to drink water. He drank 3 L and vomited. This is his CT

What happened? What should you do?

Our patient had air in the portal veins, outlining the esophagus (emphysematous esophagitis), emphysematous gastritis and associated portal venous gas.  This is all a result of a small exothermic explosion in the chest caused by the hydrogen  peroxide combining with the water he drank. 30cc of 35% hydrogen peroxide yields 3.5 liters of oxygen on decomposition. It usually forms water and oxygen gas because these are more stable than H2O2 the original molecule.  What should you do?

Nothing.  He was scoped and had minimal endothelial burns since the reaction is exothermic, but recovered completely.  His xray appears below. 

three days later the gas was gone and the pt was discharged

For those chemists out there; this  reaction can be recreated at home. First, watch the following on Utube: https://www.youtube.com/watch?v=hlW4heOo6-Q   

when dish soap and food coloring are added the result can be dramatic

You can use yeast which contains catalase as a catalyst or,  if you want a bigger amount of foam, use potassium iodide.

Emphysematous esophagitis can also occur from infectious gastritis caused by gas forming organisims.  Mucor has caused emphysematous esophagitis and death. The source of the gas can also be a necrotic gall bladder or gastric cancer. The history will dictate whether the process is benign or malignant requiring gastrectomy.

emphysematous gastritis on CT

Thanks to Dr. Semenkovich for the case.

Pritchett S, Green D, Rossos P.  Accidental ingestion of 35% hydrogen peroxide. 2007.  Can J Gastroenterol. Oct;21(10):665-667.

Gil-Dfez Lopez-Maroto, D, Cuellar E. Garcia C, et al. Emphysematous esophagitis with gastric perforation. Case Reports Rev Esp Enferm Dig. 2019 Nov;111(11):884-886.

Man Mook W, van der Geest, S. Goessens M, et al. Gas within the wall of the  stomach due to emphysematous gastritis: cas report and review. Eur J Gastroenterol Mepatol. 2002 Oct;14(10):1155-60.

Matsushima, K, Won E, Tangel M, et al. Emphysematous gastritis and gastric emphysema: similar radiographic findings, distinct clinical entities.   World J Surg.  2015 Apr;39(4):1008-17.