Ammonia toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Liquid form common in cleaning products | |||
*Ammonia gas used as chemical weapon | |||
*Injury due to inhalation, skin/eye contact, and/or ingestion | |||
*Extent of injury contingent upon concentration and duration of exposure | |||
**Even fairly low airborne concentrations (50 ppm) of ammonia produce rapid onset of eye, nose, and throat irritation; coughing; and narrowing of the bronchi. | |||
==Clinical Features== | ==Clinical Features== | ||
===Routes of Exposure=== | |||
*Inhalation | |||
**Nasopharyngeal and tracheal [[chemical burns]], upper airway obstruction | |||
**Bronchiolar/alveolar edema and narrowing | |||
**Laryngospasm (can occur immediately upon exposure) | |||
**[[Respiratory distress]]/failure, [[hypoxia]] | |||
**[[Cough]] | |||
*Skin contact | |||
**Dilute (e.g. household cleaners) rarely burn but may be irritating | |||
**Corrosive injury if contact with concentrated (e.g. industrial cleaners >25%) | |||
***Skin [[chemical burns]], blistering, pain, necrosis, particularly on moist skin areas | |||
***Contact with compressed liquid ammonia (stored at -28 °F) can cause [[frostbite]] injury and deep ulcerating burns | |||
*Eye contact | |||
**Greater tendency to penetrate/damage eye than other alkali | |||
**Temporary or permanent [[vision loss]] if contact with high concentrations of the gas or with concentrated ammonium hydroxide, due to swelling/sloughing of eye surface cells | |||
***Extent of damage may not be apparent for up to a week | |||
*Ingestion | |||
**[[Caustic ingestion|Corrosive damage]]/[[chemical burns]] to oropharynx, esophagus, stomach | |||
*** --> [[Nausea/vomiting]], [[chest pain]], [[abdominal pain]], drooling | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Caustic burn types}} | |||
{{Chemical weapon DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Decontaminate | |||
*Evaluate for extent of injury, co-intoxicants | |||
==Management== | ==Management== | ||
*Diuretics and corticosteroids not shown to be effective | |||
*Inhaled beta agonists e.g. [[albuterol]] for bronchoconstriction | |||
*See [[caustic ingestion]] | |||
*See [[caustic burns]] | |||
==Disposition== | ==Disposition== | ||
*Dependant on clinical severity | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | |||
Latest revision as of 17:11, 18 August 2019
Background
- Liquid form common in cleaning products
- Ammonia gas used as chemical weapon
- Injury due to inhalation, skin/eye contact, and/or ingestion
- Extent of injury contingent upon concentration and duration of exposure
- Even fairly low airborne concentrations (50 ppm) of ammonia produce rapid onset of eye, nose, and throat irritation; coughing; and narrowing of the bronchi.
Clinical Features
Routes of Exposure
- Inhalation
- Nasopharyngeal and tracheal chemical burns, upper airway obstruction
- Bronchiolar/alveolar edema and narrowing
- Laryngospasm (can occur immediately upon exposure)
- Respiratory distress/failure, hypoxia
- Cough
- Skin contact
- Dilute (e.g. household cleaners) rarely burn but may be irritating
- Corrosive injury if contact with concentrated (e.g. industrial cleaners >25%)
- Skin chemical burns, blistering, pain, necrosis, particularly on moist skin areas
- Contact with compressed liquid ammonia (stored at -28 °F) can cause frostbite injury and deep ulcerating burns
- Eye contact
- Greater tendency to penetrate/damage eye than other alkali
- Temporary or permanent vision loss if contact with high concentrations of the gas or with concentrated ammonium hydroxide, due to swelling/sloughing of eye surface cells
- Extent of damage may not be apparent for up to a week
- Ingestion
- Corrosive damage/chemical burns to oropharynx, esophagus, stomach
- --> Nausea/vomiting, chest pain, abdominal pain, drooling
- Corrosive damage/chemical burns to oropharynx, esophagus, stomach
Differential Diagnosis
Caustic Burns
- Caustic ingestion
- Caustic eye exposure (Caustic keratoconjunctivitis)
- Caustic dermal burn
- Airbag-related burns
- Hydrofluoric acid
- Tar burn
- Cement burn
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents (Choking agents)
- Incendiary agents
- Cyanide chemical weapon agents (Blood agents)
- Prussic acid (AKA hydrogen cyanide, hydrocyanic acid, or formonitrile)
- Nerve Agents (organophosphates)
- Acetylcholinesterase inhibitors
- Household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman)
- V-series (VX)
- Lacrimating or riot-control agents
- Pepper spray
- Chloroacetophenone
- CS
Evaluation
- Decontaminate
- Evaluate for extent of injury, co-intoxicants
Management
- Diuretics and corticosteroids not shown to be effective
- Inhaled beta agonists e.g. albuterol for bronchoconstriction
- See caustic ingestion
- See caustic burns
Disposition
- Dependant on clinical severity