Medical Management Guidelines for Hydrogen Peroxide
(H
2O
2)
CAS# 7722-84-1
UN# 2984 (8%-20%), 2014 (20%-52%), 2015 (>52%)
PDF Versionpdf icon[180 KB]
Synonyms include dihydrogen dioxide,
hydrogen dioxide, hydroperoxide, and peroxide.
- Persons exposed only to hydrogen peroxide gas do not pose
risks of secondary contamination to personnel outside the
Hot Zone. However, persons whose clothing or skin is contaminated
with concentrated hydrogen peroxide solution can secondarily
contaminate personnel by direct contact or through off-gassing
vapor.
- Hydrogen peroxide is a clear, colorless, noncombustible
liquid. It is a powerful oxidizing agent; when it comes
in contact with organic material, spontaneous combustion
can occur. Odor does not provide a warning of hazardous
concentrations.
- Hydrogen peroxide is not absorbed by the skin, but can
cause systemic toxicity when inhaled or ingested.
General Information
Description
Pure hydrogen peroxide is a crystalline
solid below 12 °F and a colorless liquid with a bitter
taste above 12 °F. It is almost always used as an aqueous
solution, which is available in dilute form (3% to 10%) for
household use and in concentrated form (greater than 30%)
for industrial use. Hydrogen peroxide is unstable, decomposing
readily to oxygen and water with release of heat. Commercial
peroxide products contain a stabilizer (usually acetanilide)
to slow the rate of spontaneous decomposition.
Hydrogen peroxide is nonflammable, but
it is a powerful oxidizing agent that can cause spontaneous
combustion when it comes in contact with organic material.
Routes of Exposure
Inhalation
Inhalation of vapors, mists, or aerosols
from concentrated solutions of hydrogen peroxide can cause
significant morbidity. Because it is nearly odorless and nonirritating
except at high concentrations, persons may not be aware of
its presence. No odor threshold was located for hydrogen peroxide
(the OSHA PEL is 1 ppm). Detection of odor does not provide
adequate warning of hazardous concentrations. Hydrogen
peroxide vapor is heavier than air and may cause asphyxiation
in enclosed, poorly ventilated, or low-lying areas.
Children exposed to the same levels of
hydrogen peroxide vapor as adults may receive larger doses
because they have greater lung surface area:body weight ratios
and increased minute volumes:weight ratios. In addition, they
may be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of hydrogen
peroxide vapor found nearer to the ground. Children may be
more vulnerable to corrosive agents than adults because of
the smaller diameter of their airways.
Skin/Eye Contact
Hydrogen peroxide is poorly absorbed
through intact skin. When used for household disinfectant
purposes (3% to 5%), it is mildly irritating to the skin and
mucous membranes. At a concentration of 10%, which is found
in some hair-bleaching solutions, it is strongly irritating
and may be corrosive.
Children are more vulnerable to toxicants
affecting the skin because of their relatively larger surface
area:body weight ratio.
Ingestion
If ingested, solutions of hydrogen peroxide
up to concentrations of 9% are generally nontoxic; however,
even a 3% solution is mildly irritating to mucosal tissue
and may cause vomiting and diarrhea. Ingestion of industrial-strength
solutions ( 10%) causes systemic toxicity and has been
associated with fatalities.
Sources/Uses
In industry, hydrogen peroxide is used
as a bleach for textiles and paper, as a component of rocket
fuels, and as a reagent for producing foam rubber and organic
chemicals. In the home, dilute hydrogen peroxide solutions
are used as disinfectants, deodorants, and hair-bleaching
agents.
Standards and Guidelines
OSHA PEL (permissible exposure limit):
1 ppm (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 75 ppm
AIHA ERPG-2 (emergency response planning
guideline) (maximum airborne concentration below which it
is believed that nearly all individuals could be exposed for
up to 1 hour without experiencing or developing irreversible
or other serious health effects or symptoms which could impair
an individual's ability to take protective action) = 50 ppm
Physical Properties
Description: Colorless liquid
at room temperature; used commonly in aqueous solution.
Warning properties: Odor is inadequate
as index of exposure
Molecular weight: 34.0 daltons
Boiling point (760 mm Hg): 286 °F
(141 °C)
Freezing point: 12 °F (-11.1 °C)
Specific gravity: 1.39 at 68 °F
(20 °C) (water = 1)
Vapor pressure: 5 mm Hg at 86 °F
(30 °C)
Gas density: 1.2 (air = 1) (heavier
than air)
Water solubility: Miscible with
water
Flammability: Nonflammable, but
a powerful oxidizer and may ignite any organic matter with
which it comes in contact
Incompatibilities
Hydrogen peroxide reacts with oxidizable
materials, iron, copper, brass, bronze, chromium, zinc, lead,
manganese, and silver. Contact with organic materials may
result in spontaneous combustion.
Health Effects
- Hydrogen peroxide is corrosive to skin, eyes, and mucous
membranes at high concentrations (>10%); lower concentrations
may cause irritation.
- Other effects occur from inhalation or ingestion and may
include gas embolism, gastric irritation, gastric distension
and emesis, an accumulation of fluid in the lungs, unconsciousness,
and respiratory arrest.
- Symptoms become more severe as the concentration of hydrogen
peroxide increases.
Acute Exposure
The systemic effects of hydrogen peroxide
result from its interaction with catalase in the tissues with
the liberation of oxygen and water as it decomposes. One milliliter
of 3% hydrogen peroxide liberates 10 mL of oxygen. When the
amount of oxygen evolved exceeds the maximum blood solubility,
venous embolism occurs. Intravascular oxygen embolism may
also occur. Ingestion of dilute solutions (3-10%) produces
mild gastrointestinal irritation, gastric distension and emesis,
and on rare occasions, gastrointestinal erosions or embolism.
Ingestion of 10-20% solutions produces similar symptoms, but
exposed tissues may also be burned. Ingestion of 20-40% produces
the symptoms described for lower concentrations, but may also
induce rapid loss of consciousness followed by respiratory
arrest.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Vapors, mists, or aerosols of hydrogen
peroxide can cause upper airway irritation, inflammation of
the nose, hoarseness, shortness of breath, and a sensation
of burning or tightness in the chest. Exposure to high concentrations
can result in severe mucosal congestion of the trachea and
bronchi and delayed accumulation of fluid in the lungs.
Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways.
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
CNS
Inhalation or ingestion of high concentrations
of hydrogen peroxide may result in seizures, cerebral infarction,
or cerebral embolism. The ensuing damage to the CNS may cause
permanent neurological deficits or death.
Dermal
Prolonged exposure to concentrated vapor
or to dilute solutions can cause irritation and temporary
bleaching of skin and hair. Contact with concentrated solutions
can cause severe skin burns with blisters.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
affecting the skin.
Ocular
Exposure to concentrated vapor, mist,
or aerosol can cause stinging pain and tearing. Solutions
that are 5% or greater can cause injury to the eye surface
if splashed in the eye (sometimes with delayed effects).
Gastrointestinal
Ingestion of household solutions (3%)
usually causes mild mucosal irritation and vomiting. Gastric
distention due to liberation of oxygen in the stomach may
occur, but hollow-organ rupture is uncommon when dilute solutions
are ingested.
Ingestion of concentrated solutions ( 10%)
can cause extreme irritation, inflammation, and burns of the
alimentary tract can occur, and hollow-organ distention and
rupture is a significant danger. Hydrogen peroxide enemas
have caused colonic rupture, intestinal gangrene with gas
bubbles, and acute ulcerative colitis.
Potential Sequelae
Survivors of severe inhalation injury
may sustain permanent lung damage. Severe eye exposures may
result in ulceration of the eye and blindness. Permanent neurological
deficits have also been reported.
Chronic Exposure
Because hydrogen peroxide is rapidly
decomposed in the body, it is unlikely to cause chronic toxicity.
However, repeated exposures to hydrogen peroxide vapor may
cause chronic irritation of the respiratory tract and partial
or complete lung collapse. Repeated contact with vapor or
solution may result in bleaching of skin and hair.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
The International Agency for Research
on Cancer (IARC) has determined that hydrogen peroxide is
not classifiable as to its carcinogenicity to humans.
Developmental and Reproductive Effects
Hydrogen peroxide is not included in
Reproductive and Developmental Toxicants, a 1991 report
published by the U.S. General Accounting Office (GAO) that
lists 30 chemicals of concern because of widely acknowledged
reproductive and developmental consequences. No reports were
located on the developmental or reproductive effects of hydrogen
peroxide in humans.
Prehospital Management
- Victims exposed only to hydrogen peroxide vapor do not
pose substantial risks of secondary contamination to personnel
outside the Hot Zone. Victims whose clothing or skin is
contaminated with concentrated hydrogen peroxide solution
can secondarily contaminate personnel by direct contact
or through off-gassing vapor.
- Hydrogen peroxide is corrosive to skin, eyes, and mucous
membranes at high concentrations (>10%); lower concentrations
may cause irritation. Symptoms become more severe as the
concentration of hydrogen peroxide increases.
- Other effects occur from inhalation or ingestion and may
include gas embolism, gastric irritation, gastric distension,
gastric rupture and emesis, an accumulation of fluid in
the lungs, unconsciousness, and respiratory arrest.
- There is no antidote for hydrogen peroxide. Treatment
consists of support of respiratory and cardiovascular functions.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Hydrogen peroxide vapor is a severe respiratory
tract irritant. Hydrogen peroxide solutions are corrosive
at high concentrations (>10%); lower concentrations may
cause irritation.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of hydrogen peroxide.
Skin Protection: Chemical-protective
clothing is recommended for concentrations greater than 10%
because hydrogen peroxide can cause skin irritation and burns.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
Patients exposed only to hydrogen peroxide
vapor who have no skin or eye irritation may be transferred
immediately to the Support Zone. Other patients will require
decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Remove contaminated clothing while
flushing exposed areas. Double-bag contaminated clothing and
personal belongings.
Flush liquid-exposed skin and hair with
plain water for at least 5 minutes. Wash exposed area extremely
thoroughly with soap and water.Use caution to avoid hypothermia
when decontaminating children or the elderly. Use blankets
or warmers when appropriate.
Flush exposed or irritated eyes with
copious amounts of plain water or saline for at least 15 minutes.
Remove contact lenses if easily removable without additional
trauma to the eye. If a corrosive material is suspected or
if pain or injury is evident, continue irrigation while transferring
the victim to the Support Zone.
In cases of ingestion, do not induce
emesis. Victims who are conscious and able to swallow
should be given 4 to 8 ounces of milk or water. If the victim
is symptomatic, delay decontamination until other emergency
measures have been instituted. Activated charcoal has not
been shown to absorb hydrogen peroxide and will interfere
with endoscopy which will be necessary to assess tissue damage.
Consider appropriate management of chemically
contaminated children at the exposure site. Provide reassurance
to the child during decontamination, especially if separation
from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination or who have been exposed
only to vapor pose no serious risks of secondary contamination.
In such cases, Support Zone personnel require no specialized
protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis. Victims who are conscious and able to swallow
should be given 4 to 8 ounces of milk or water. If the victim
is symptomatic, delay decontamination until other emergency
measures have been instituted. Activated charcoal has not
been shown to absorb hydrogen peroxide and will interfere
with endoscopy which will be necessary to assess tissue damage.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Hydrogen peroxide poisoning is not known
to pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If a chemical has been ingested, prepare
the ambulance in case the victim vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients who have obvious injury, such
as severe wheezing, dyspnea, or skin or eye burns, should
be transported immediately to a medical facility for evaluation.
Patients who have ingested hydrogen peroxide solutions (except
minor ingestions of household strength solutions (3% to 5%)
should also be transported for medical evaluation.
Persons who have no eye, skin, or throat
irritation or who have mild or transient symptoms are unlikely
to develop severe complications. They may be discharged at
the scene after their names, addresses, and telephone numbers
are recorded. Those discharged should be advised to seek medical
care promptly if symptoms of toxicity develop (see Patient
Information Sheet below).
Emergency Department Management
- Hospital personnel can be secondarily contaminated by
direct contact or from vapor off-gassing from heavily soaked
clothing or from the vomitus of victims who have ingested
hydrogen peroxide. Patients do not pose contamination risks
after contaminated clothing is removed and the skin is thoroughly
washed.
- Hydrogen peroxide is corrosive to skin, eyes, and mucous
membranes at high concentrations (>10%); lower concentrations
may cause irritation. Symptoms become more severe as the
concentration of hydrogen peroxide increases.
- Other effects occur from inhalation or ingestion and may
include gas embolism, gastric irritation, gastric distension,
gastric rupture and emesis, an accumulation of fluid in
the lungs, unconsciousness, and respiratory arrest.
- There is no antidote for hydrogen peroxide poisoning.
Treatment consists of support of respiratory and cardiovascular
functions.
Decontamination Area
Previously decontaminated patients and
patients exposed only to hydrogen peroxide vapor who have
no skin or eye irritation may be transferred immediately to
the Critical Care Area. Other patients will require decontamination
as described below.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
affecting the skin. Also, emergency room personnel should
examine children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. In cases of respiratory compromise secure airway
and respiration via endotracheal intubation. If not possible,
surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Hydrogen peroxide poisoning is not known
to pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination.
Because concentrated hydrogen peroxide
can cause burns, ED staff should don chemical resistant jumpsuits
(e.g., of Tyvek or Saranax) or butyl rubber aprons, rubber
gloves, and eye protection if the patient's clothing or skin
is wet with hydrogen peroxide. After the patient has been
decontaminated, no special protective clothing or equipment
is required for ED personnel.
Quickly remove contaminated clothing
while flushing the exposed skin with water (preferably under
a shower). Double-bag the contaminated clothing and personal
belongings. Wash skin thoroughly with soap and water.Use caution
to avoid hypothermia when decontaminating children or the
elderly. Use blankets or warmers when appropriate.
Irrigate exposed or irritated eyes with
copious amounts of plain water or saline for at least 15 minutes.
Remove contact lenses if easily removable without additional
trauma to the eye. If a corrosive material is present or if
pain or injury is evident, continue irrigation while transporting
the patient to the Critical Care Area.
In cases of ingestion, do not induce
emesis. Victims who are conscious and able to swallow
should be given 4 to 8 ounces of milk or water if this has
not been done already. If the victim is symptomatic, delay
decontamination until other emergency measures have been instituted.
Activated charcoal has not been shown to absorb hydrogen peroxide
and will interfere with endoscopy which will be necessary
to assess tissue damage.
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children
may be more vulnerable to corrosive agents than adults because
of the relatively smaller diameter of their airways. Establish
intravenous access in seriously ill patients if this has not
been done previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Hydrogen peroxide poisoning is not known
to pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Skin Exposure
If concentrated hydrogen peroxide solution
was in contact with the skin, chemical burns may result; treat
as thermal burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
affecting the skin.
Eye Exposure
Continue irrigation for at least 15 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have corneal injuries.
Ingestion Exposure
Do not induce emesis. Victims
who are conscious and able to swallow should be given 4 to
8 ounces of milk or water if this has not been done already.
If the victim is symptomatic, delay decontamination until
other emergency measures have been instituted. Activated charcoal
has not been shown to absorb hydrogen peroxide and will interfere
with endoscopy which will be necessary to assess tissue damage.
Consider endoscopy to evaluate the extent
of gastrointestinal tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyroidotomy.
Gastric lavage is useful in certain circumstances to remove
caustic material and prepare for endoscopic examination. Consider
gastric lavage with a small nasogastric tube if: (1) a large
dose has been ingested; (2) the patient's condition is evaluated
within 30 minutes; (3) the patient has oral lesions or persistent
esophageal discomfort; and (4) the lavage can be administered
within 1 hour of ingestion. Care must be taken when placing
the gastric tube because blind gastric-tube placement may
further injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless performed under endoscopic guidance.
Toxic vomitus or gastric washings should
be isolated (e.g., by attaching the lavage tube to isolated
wall suction or another closed container).
Large ingestions may produce gastritis
from hydrogen peroxide decomposition, which releases large
volumes of oxygen and causes gastric distention. Gently place
a small nasogastric tube to relieve distention or to perform
lavage on an obtunded patient. Most ingestions of dilute hydrogen
peroxide are benign, and mild irritation is self-limited.
Antidotes and Other Treatments
There is no antidote for hydrogen peroxide
poisoning. Enhanced elimination methods are neither necessary
nor effective. Hyperbaric oxygen has been used in severe embolization
cases, but there are no controlled studies of the efficacy
of this treatment. Careful aspiration of air through a central
venous line may be attempted for patients in extremis.
Laboratory Tests
The diagnosis of acute hydrogen peroxide
toxicity is primarily clinical based on eye and skin irritation
or burns, white foam from the mouth, and gastric irritation.
Routine laboratory studies for all exposed patients include
CRC, glucose, and electrolyte determinations. For patients
exposed through inhalation, useful studies include chest radiography,
pulse oximetry (or ABG measurements), spirometry, and peak
flow measurements. A radiograph of the abdomen and chest is
advised if there are symptoms, or if a high concentration
is ingested to detect intravascular oxygen embolization. Ingestion
of hydrogen peroxide can be assessed by adding 1 drop of 15%
titanium chloride to an acidified mixture of equal parts of
gastric contents and ethyl ether. A yellow to deep orange
coloration of the aqueous layer indicates the formation of
H2TiO4 which is an indication of ingested
peroxide.
Disposition and Follow-up
Consider hospitalizing symptomatic patients
who have histories of substantial inhalation exposure and
patients who have ingested a concentrated solution of hydrogen
peroxide.
Delayed Effects
Patients who have complaints of chest
pain, chest tightness, or cough should be observed for 24
to 72 hours and reexamined periodically to detect delayed-onset
pulmonary edema or respiratory failure.
Patient Release
Patients who remain asymptomatic for
4 to 6 hours may be discharged with instructions to seek medical
care promptly if symptoms develop (see the Hydrogen Peroxide-Patient
Information Sheet below).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Patients who have corneal injuries or
severe skin burns should be reexamined within 24 hours.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
hydrogen peroxide.
Print instructions only.pdf icon[PDF - 31.2 KB]
What is hydrogen peroxide?
Hydrogen peroxide is used widely in industry
to bleach cloth and paper and to manufacture other chemicals.
It is also an ingredient of some rocket fuels. Hydrogen peroxide
is found in dilute form (3% to 10%) in the home and in concentrated
form (30% or greater) in industry. In the home, 3% solutions
of hydrogen peroxide are used as disinfectants for cuts and
scrapes, and slightly more concentrated solutions (10%) are
used in hair bleaches. Dilute solutions have almost no odor,
but stronger solutions have a sharp odor. Hydrogen peroxide
is not flammable, but concentrated solutions may cause combustion
of organic materials.
What immediate health effects can be caused by exposure to hydrogen peroxide?
Depending on the concentration, breathing
hydrogen peroxide vapor can cause eye and throat irritation,
coughing, and breathing difficulty. Serious eye or skin burns
and bleaching of the hair may result from contact with hydrogen
peroxide solutions. Drinking a concentrated hydrogen peroxide
solution can cause vomiting and severe burns of the throat
and stomach. Generally, the more serious the exposure, the
more severe the symptoms.
Can hydrogen peroxide poisoning be treated?
There is no proven antidote for hydrogen
peroxide poisoning, but its effects can be treated, and most
persons get well. Persons who have experienced serious symptoms
may need to be hospitalized.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a severe exposure, a person may not
notice any symptoms for up to 24 hours, but may develop lung
damage.
What tests can be done if a person has been exposed to hydrogen peroxide?
There are no specific blood and urine
tests that can show whether a person has been exposed to hydrogen
peroxide. However, blood tests and a chest x-ray may be used
to evaluate lung injury. Testing is not needed in every case.
Where can more information about hydrogen peroxide be found?
More information about hydrogen peroxide
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[PDF - 31.2 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing, difficulty breathing or shortness of breath
- wheezing, chest pain or tightness
- increased redness or pain or a pus-like discharge from
injured skin, eyes, or other wound
- stomach pain or vomiting
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.