Hydrogen peroxide ingestion: can bedside ultrasound help?

http://www.youtube.com/watch?v=ed6mpRKmx14 3 out of 5 stars Young Woman With Epigastric Pain and Vomiting. Manning EP et al. Ann Emerg Med 2014 Sep;64:330. Full Text This brief case is part of the Annals of Emergency Medicines‘s series “Image of the Month.” A 23-year-old woman develops epigastric pain and vomiting after investing a cleaning agent. Abdominal exam was unremarkable. a CT of the abdomen demonstrated gas in the portal veins. The cleaning agent was hydrogen peroxide, which causes injury by two mechanisms: 1) corrosive tissue injury, and 2) gas formation. A previous case report indicated that even dilute 3% hydrogen peroxide can cause gas emboli to the portal system. Images that accompany this case reveal erosions in the esophagus and stomach, as well as gas embolization to the portal veins. The patient was treated with hyperbaric oxygen with resolution of her abdominal pain. It would have been interesting to see a bedside ultrasound in this case. Gas in the portal veins should show up as unusual hyperechoic densities in the liver. This may be an indication for referral to a hyperbaric oxygen center. The video clip above is not from this case, but nicely illustrates ultrasound findings associated with gas in the portal system. Additional images can be seen here. My recent column in Emergency Medicine News discussed other possible uses for bedside ultrasound imaging in toxicology cases.
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical bedside emergency ultrasound gas in portal vein hydrogen peroxide ingestion overdose Source Type: news