May 2019

In this VETgirl online veterinary continuing education blog, we review the use of hydrogen peroxide as an emetic agent in dogs. Please note, this blog does NOT apply to cats, who require their own unique emetic agents! Stay tuned for a future blog on that.

If you haven’t kept up on your veterinary journals, this blog is for you (Or better yet, why aren’t you subscribing to our VETgirl podcasts on Apple podcasts or Spotify?). A recent paper by Niedzwecki et al came out in JAVMA 2017 and found that the use of hydrogen peroxide (H202) as an emetic agent in dogs resulted in gastritis, esophagitis and even gastric ulcers when used in dogs (1). This was based on a prospective study where endoscopy was performed several times after peroxide administration.

So, what should we use as an emetic agent in dogs (at home, by pet owners) or in the veterinary clinic? When using emetic agents in the veterinary poisoned patient, it is important to pick one that is safe yet effective. Emetic agents work by causing local gastric irritation, stimulating the central nervous system (CNS) chemoreceptor trigger zone (CRTZ), or a combination of gastric irritation and CNS stimulation.(2,3) Considerations in choosing an emetic agent are broad and varied. Many home or Internet remedies are used without success and have the potential of causing further harm. Emetic agents are not effective if an antiemetic such as ondansetron or maropitant has been previously administered. Currently, the only home recommendation for dog owners is hydrogen peroxide (if available), while veterinary-prescribed emetic agents include apomorphine hydrochloride (dog).(2,3)

Hydrogen peroxide (H2O2) works by local irritation of the oropharynx and gastric lining, which results in a gag reflex. It is usually recommended for oral administration by the dog owner when transportation to a veterinary clinic is delayed. Only a 3% hydrogen peroxide solution should be used, as higher concentrations can potentially be corrosive to the gastrointestinal (GI) mucosa. Adverse effects associated with use of H2O2 as an emetic agent include irritation to the GI tract, gastroduodenal lesions, gastric dilatation and/or volvulus (dogs), and potential for aspiration pneumonia.(1-3) When using hydrogen peroxide as an emetic agent in dogs, the administration of sucralfate and antacids (e.g., proton-pump inhibitors or H2 blockers) should be considered.

Methods that are not recommended for emesis induction include digital induction of emesis, syrup of ipecac, liquid soaps, dry mustard powders, and salt. Digital induction of emesis often results in physical injury to the pet owner (dog bite), or injury to the pet’s throat and soft palate. Syrup of ipecac has historically been recommended to induce emesis, but is no longer the standard of care. Its cardiotoxic potential and tendency to result in prolonged vomiting, lethargy, and diarrhea have caused it to fall out of favor in both human and veterinary medicine.(2,3) Soaps, mustard powders, and table salt are not reliable as induction agents and may be detrimental (e.g., resulting in further complications such as hypernatremia of the patient).

If you’re using apomorphine, great – keep on keeping on. But if you’re using hydrogen peroxide in the veterinary clinic as an emetic agent, please be aware that you should be adding on an antacid (e.g., either a proton pump inhibitor or H2 blocker) and stomach protectant (e.g., sucralfate) orally for 5-7 days, as needed.

When in doubt, contact the ASPCA Animal Poison Control Center (888) 426-4435) for more life saving information!

1. Niedzwecki AH, Book BP, Lewis KM, et al. Effects of oral 3% hydrogen peroxide used as an emetic on the gastroduodenal mucosa of healthy dogs. J Vet Emerg Crit Care 2017;27(2):178-184.
2. Lee JA. Decontamination of the Poisoned Patient. In: Osweiler G, Hovda L, Brutlag A, Lee JA, ed. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp. 5-19.
3. Peterson ME. Toxicological Decontamination. In: Peterson ME, Talcott PA, ed. Small Animal Toxicology, 2nd Ed. St. Louis: Elsevier Saunders, 2006, pp. 127-141.

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