Case Report: Aspiration Pneumonitis as a Rare Complication Following Hydrogen Peroxide Intoxication

Authors

  • Maulinda Putri Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
  • Suhartomi Faculty of Medicine, Dentistry, and Health Science, Universitas Prima Indonesia, Medan, Indonesia
  • OK Yulizal Faculty of Medicine, Dentistry, and Health Science, Universitas Prima Indonesia, Medan, Indonesia
  • Siti Syarifah Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v31i4.3404

Keywords:

hydrogen peroxide, intoxication, pneumonitis, suicide

Abstract

Introduction: Suicide rates continue to rise globally, with self-poisoning being a common method in some developing countries. This report reported a case of hydrogen peroxide ingestion leading to aspiration pneumonitis, a less-discussed complication compared to gastrointestinal toxicity. Case Illustration: A 41-year-old woman presented to the emergency unit 8 hours post-ingestion of a hydrogen peroxide-based toilet cleaner. Symptoms included vomiting, hoarseness, faintness, and frothing at the mouth. The physical examination revealed dyspnea, irritability, a cleaning solution odor in the oral cavity, rhonchi in the middle and lower lung fields, epigastric tenderness, and increased bowel sounds. Gastric lavage with 200 mL of saline was performed, and activated charcoal and sucralfate syrup were administered via a nasogastric tube. The patient had previously received ranitidine at another facility and was also treated with omeprazole and ondansetron. Laboratory results showed leukocytosis, and a chest x-ray indicated bilateral lung infiltration and increased broncho-vascular pattern. Discussion: Early and proper intervention by trained healthcare professionals, combined with preventive measures such as positioning the patient in a semi-upright position and avoiding emetogenic liquids, is essential. Conclusion: This case showed the importance of prompt management involving gastric lavage, mucosal protection, acid suppression, and absorption inhibition. Nonetheless, respiratory complications, such as aspiration pneumonitis, remain challenging to prevent.

Author Biographies

Maulinda Putri, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Department of Internal Medicine

Suhartomi, Faculty of Medicine, Dentistry, and Health Science, Universitas Prima Indonesia, Medan, Indonesia

Department of Pharmacology

OK Yulizal, Faculty of Medicine, Dentistry, and Health Science, Universitas Prima Indonesia, Medan, Indonesia

Department of Internal Medicine

Siti Syarifah, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Department of Pharmacology and Therapeutic

References

Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int J Environ Res Public Health [Internet]. 2018 [cited 2024 Oct 10];15(1425):1–23. Available from: https://doi.org/10.3390/ijerph15071425

Valentina TD, Helmi AF. Ketidakberdayaan dan perilaku bunuh diri: meta-analisis. Bul Psikol [Internet]. 2016 [cited 2024 Oct 10]; 24(2):123–35. Available from: https://doi.org/10.22146/buletinpsikologi.18175

Breier Y, Kushmakov R, Banks WD, Guan B, Langan D. Suicide attempt by a corrosive agent causing unusual outcomes and complications. Cureus [Internet]. 2023 [cited 2024 Oct 10]; 15(8):10–2. Available from: https://doi.org/10.7759/cureus.42861

Maharani SD. Fenomena bunuh diri tinjauan filsafat manusia (studi kasus terhadap fenomena bunuh diri ibu dan anak). J Filsafat [Internet]. 2007;17(1) [cited 2024 Oct 17];100–12. Available from: https://doi.org/10.22146/jf.23235

Alrasheed FK, Alowairdhi YA, Alkharashi YM, Alomar AO, Alqirnas MQ, Alhussaini NA, et al. Suicide attempts by poisoning: an experience from a high-volume emergency department. Cureus [Internet]. 2022 [cited 2024 Oct 19];14(3). Available from: https://doi.org/10.7759/cureus.23330

Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol [Internet]. 2019 [cited 2024 Oct 21]; 49(8):637-69. Available from: https://doi.org/10.1080/10408444.2019.1707773

Gravagnuolo R, Tambuzzi S, Gentile G, Boracchi M, Crippa F, Madeddu F, et al. Is it correct to consider caustic ingestion as a nonviolent method of suicide? a retrospective analysis and psychological considerations. Int J Environ Res Public Health [Internet]. 2023 [cited 2024 Oct 21]; 20(13). Available from: https://doi.org/10.3390/ijerph20136270.

Yusuf F, Abubakar A, Maghfirah D, Heltomi M, Isitua CC. Gastrointestinal mucosal damages caused by ingestion of corrosive substances: a Case study of hydrochloric acid and sodium hydroxide. Narra J [Internet]. 2023 [cited 2024 Oct 19]; 3(3):1–9. Available from: https://doi.org/10.52225/narra.v3i3.259

Targhan H, Evans P, Bahrami K. A review of the role of hydrogen peroxide in organic transformations. J Ind Eng Chem [Internet]. 2021 [cited 2024 Oct 18]; 104: 295–332. Available from: https://doi.org/10.1016/j.jiec.2021.08.024

Rohith G, Rajesh BS, Archana E, Srinivasan K. Hydrogen Peroxide poisoning-a rare cause of portal venous gas. Indian J Radiol Imaging [Internet]. 2021 [cited 2024 Oct 21]; 31(2):492–4. Available from: https://doi.org/10.1055/s-0041-1734354

Hallett TC, Klein L, Dunnavant D, Weatherly AJ, Kidd RS, Bruccoleri RE. Imaging use after 35% hydrogen peroxide ingestion by a 3-year-old: a case report. Toxicol Commun. 2023 [cited 2024 Oct 22]; 7(1): 1-4. Available from: https://doi.org/10.1080/24734306.2023.2203367

Duc ND, Sinh NP, Anh LNH. Clinical case report of hydrogen peroxide poisoning is treated by hyperbaric oxygen therapy. Eurasian J Emerg Med [Internet]. 2024 [cited 2024 Oct 21]; 23(2):149–51. Available from: https://doi.org/10.4274/eajem.galenos.2024.99076

Sung J, Cossarini F, Palaiodimos L, Benson B, Meholli M. Extra oxygen leads to bubble trouble: portal vein gas embolism from 3% hydrogen peroxide ingestion. Cureus [Internet]. 2018 [cited 2024 Oct 18]; 10(2): e2136. Available from: https://doi.org/10.7759/cureus.2136

Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med. 2017;17(1):1. Available from: https://doi.org/10.17245/jdapm.2017.17.1.1

Swain R, Behera C, Gupta SK. Fatal corrosive ingestion: a study from South and South-East Delhi, India (2005–2014). Med Sci Law [Internet]. 2016 [cited 2024 Oct 19]; 56(4):252–7. DOI: 10.1177/0025802416657762

Mohan H. Textbook of pathology. Eighth Edition. New Delhi: Jaypee; 2019. 21–60; 592–648 p.

Tseng YL, Wu MH, Lin MY, Lai WW. Outcome of acid ingestion related aspiration pneumonia. Eur J Cardio-thoracic Surg [Internet]. 2002 [cited 2024 Oct 29]; 21(4):638–43 Available from: https://doi.org/10.1016/s1010-7940(02)00045-3

Kumar JP, Jain D, Dahiya S, Duhan R. Accidental aspiration of diesel during siphoning causing chemical pneumonitis. Indian Pract [Internet]. 2021 [cited 2024 Nov 2]; 73(1): 26-8. Available from https://www.articles.theindianpractitioner.com/index.php/tip/article/download/1110/1016

Haryati, Nor Muhammad. Pneumonitis due to barium aspiration in patient with ischemic stroke and bronchoesophageal fistulae. International Journal of Respiratory Medicine [Internet]. 2019 [cited 2024 Nov 3]; 1(2): 45-51. Available from http://ijrm.respirology-usu.id/index.php/ijrm

Andrés CMC, Pérez de la Lastra JM, Juan CA, Plou FJ, Pérez-Lebeña E. Chemistry of hydrogen peroxide formation and elimination in mammalian cells, and its role in various pathologies. Stresses [Internet]. 2022 [cited 2024 Oct 22]; 2(3):256–74. Available from: https://doi.org/10.3390/stresses2030019

Neill S, Dean N. Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Curr Opin Infect Dis [Internet]. 2019 [cited 2024 Oct 22]; 32(2):152–7. Available from: https://doi.org/10.1097/QCO.0000000000000524

McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic & clinical pharmacology. 15th ed. New York: Mc Graw Hill Lange; 2021. p. 1081–114.

Djoko W, Katu S. Dasar-dasar keracunan. In: Setyohadi B, Arsana PM, Soeroto AY, Suryanto A, Abdullah M, editors. EIMED PAPDI. Jakarta: Perhimpunan Dokter Spesialis Penyakit Dalam; 2017. p. 630–55.

Purnomo HD. Gastritis erosif akut. In: Setyohadi B, Arsana PM, Soeroto AY, Suryanto A, Abdullah M, editors. EIMED PAPDI. Jakarta: Perhimpunan Dokter Spesialis Penyakit Dalam; 2017. p. 198–211.

Aguinaco A, Pocostales JP, García-Araya JF, Beltrán FJ. Decomposition of hydrogen peroxide in the presence of activated carbons with different characteristics. J Chem Technol Biotechnol [Internet]. 2011 [cited 2024 Nov 4]; 86(4):595–600. Available from: https://doi.org/10.1002/jctb.2560

Sukmawati SH, Sunarto S. Utilization of coffee waste as active charcoal for purification of waste cooking oil. Indones J Chem Environ [Internet]. 2021 [cited 2024 Nov 10];3(2):29–38. Available from: https://doi.org/10.21831/ijce.v3i2.43510

Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, et al. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: a systematic review with meta-analysis. Sci Rep [Internet]. 2016 [cited 2024 Nov 12]; 6(June): 1–2. Available from: https://doi.org/10.1038/srep38097

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Published

2025-07-30

How to Cite

Putri, M. ., Suhartomi, OK Yulizal, & Syarifah, S. . (2025). Case Report: Aspiration Pneumonitis as a Rare Complication Following Hydrogen Peroxide Intoxication. Jurnal Kedokteran Meditek, 31(4). https://doi.org/10.36452/jkdoktmeditek.v31i4.3404

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Section

Laporan Kasus