Etiology of Ammonia Inhalation

• Anhydrous Ammonia: gas at room temperature
  • Commercial Refrigerant
  • Farming: ammonia is used as a fertilizer
  • Illicit Methamphetamine Labs
• Aqueous Ammonia: liquid at room temperature
  • Household Cleaning Solutions

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Physiology of Ammonia Inhalation

• Inhalational Exposure to Anhydrous Ammonia Gas
  • Highly soluble in water -> immediately affects upper airway and conjunctiva
  • Upper airway effects usually elicit early escape before damage occurs

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Clinical Manifestations of Ammonia Inhalation

Pulmonary Manifestations

• Upper Airway Irritation: anhydrous ammonia gas immediately affects upper airway
• Upper Airway Obstruction-Laryngeal Edema (see Obstructive Lung Disease)
• Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS)
  • Diagnosis
    • FOB: may be necessary to rule out airway mucosal injury
    • OLB: diffuse alveolar damage
  • Clinical: delayed onset of pulmonary injury is unusual
  • Treatment
    • Steroids: may be benficial in acute lung injury, but are unproven
• Reactive Airway Dysfunction Syndrome (see Reactive Airway Dysfunction Syndrome)
• Bronchiolitis Obliterans (see Bronchiolitis Obliterans)
• Bronchiectasis (see Bronchiectasis)
  • Epidemiology: case reports

Other Manifestations

• Conjunctival Irritation: anhydrous ammonia gas immediately affects conjunctiva
• Contact Dermatitis-Irritant Type (see Contact Dermatitis)
• Residual Olfactory Effects: decreased olfactory acuity

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References

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