Medical Management Guidelines for Ammonia
(NH3)
CAS# 7664-41-7
UN# 2672 (between 12% and 44% solution), 2073 (>44% solution), 1005 (anhydrous gas or >50% solution)
PDF Versionpdf icon[183 KB]
Synonyms include ammonia gas, anhydrous
ammonia, and liquid ammonia. Aqueous solutions are referred to as aqueous ammonia, ammonia solution, and ammonium hydroxide.
- Persons exposed only to ammonia gas do not pose significant
risks of secondary contamination to personnel outside the
Hot Zone. Persons whose clothing or skin is contaminated
with liquid ammonium hydroxide can secondarily contaminate
response personnel by direct contact or through off-gassing
ammonia vapor.
- Ammonia dissolves readily in water to form ammonium hydroxide
a corrosive, alkaline solution at high concentrations.
- Ammonia's pungent odor and irritating properties usually
provide adequate warning of its presence; however, olfactory
fatigue can occur. Inhalation can result in fatalities.
General Information
Description
At room temperature, anhydrous ammonia
is a colorless, highly irritating gas with a pungent, suffocating
odor. It is lighter than air and flammable, with difficulty,
at high concentrations and temperatures. It is easily compressed
and forms a clear, colorless liquid under pressure. Anhydrous
ammonia is hygroscopic. Ammonia dissolves readily in water
to form ammonium hydroxide-an alkaline solution. The concentration
of aqueous ammonia solutions for household use is typically
5% to 10% (weight:volume), but solutions for commercial use
may be 25% (weight:volume) or more and are corrosive. Aqueous
ammonia is commonly stored in steel drums. Anhydrous ammonia
is stored and shipped in pressurized containers, fitted with
pressure-relief safety devices, and bears the label "Nonflammable
Compressed Gas". Despite not meeting the Department of
Transport definition of flammable it should be treated as
such.
Routes of Exposure
Inhalation
Inhalation of ammonia may cause nasopharyngeal
and tracheal burns, bronchiolar and alveolar edema, and airway
destruction resulting in respiratory distress or failure.
Ammonia's odor threshold is sufficiently low to acutely provide
adequate warning of its presence (odor threshold = 5 ppm;
OSHA PEL = 50 ppm). However, ammonia causes olfactory fatigue
or adaptation, making its presence difficult to detect when
exposure is prolonged. Anhydrous ammonia is lighter than air
and will therefore rise (will not settle in low-lying areas);
however, vapors from liquefied gas are initially heavier than
air and may spread along the ground. Asphyxiation may occur
in poorly ventilated or enclosed.
Children exposed to the same levels of
ammonia vapor as adults may receive larger dose because they
have greater lung surface area:body weight ratios and increased
minute volumes:weight ratios. In addition, they may be exposed
to higher levels than adults in the same location because
of their short stature and the higher levels of ammonia vapor
found nearer to the ground.
Skin/Eye Contact
The extent of injury produced by exposure
to ammonia depends on the duration of the exposure and the
concentration of the gas or liquid. Even low airborne concentrations
(100 ppm) of ammonia may produce rapid eye and nose irritation.
Higher concentrations may cause severe eye injury. Contact
with concentrated ammonia solutions, such as some industrial
cleaners (25%), may cause serious corrosive injury, including
skin burns, permanent eye damage, or blindness. The full extent
of damage to the eyes may not be clear until up to 1 week
after the injury is sustained. Contact with liquefied ammonia
can cause frostbite injury.
Children are more vulnerable to toxicants
that affect the skin because of their relatively larger surface
area:body weight ratio.
Ingestion
Ingestion of ammonium hydroxide, while
uncommon, results in corrosive damage to the mouth, throat,
and stomach. Ingestion of ammonia does not normally result
in systemic poisoning.
Sources/Uses
Ammonia is manufactured by reacting hydrogen
with nitrogen. About 80% of the ammonia produced is used in
fertilizers. It is also used as a refrigerant gas, and in
the manufacture of plastics, explosives, pesticides, and other
chemicals, as a corrosion inhibitor, in the purification of
water supplies, as a component of household cleaners, in the
pulp and paper, metallurgy, rubber, food and beverage, textile
and leather industries, and in the manufacture of pharmaceuticals.
Ammonia is also produced naturally from decomposition of organic
matter and under unusual conditions, can reach dangerous concentrations.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 50 ppm (8-hour TWA).
NIOSH IDLH (immediately dangerous to
life or health) = 300 ppm.
AIHA ERPG-2 (the maximum airborne concentration
below which it is believed that nearly all individuals could
be exposed for up to 1 hour without experiencing or developing
irreversible or other serious health effects or symptoms which
could impair an individual's ability to take protective action)
= 200 ppm.
Physical Properties
Description: Clear, colorless
gas at room temperature; easily liquefied; readily dissolves
in water to form caustic solutions.
Warning properties: Pungent odor
at ~5 ppm; eye irritation at 20 ppm
Molecular weight: 17.0 daltons
Boiling point (760 mm Hg): -28ĀŗF
(-33.4ĀŗC)
Vapor pressure: >6,000 mm Hg
at 68ĀŗF (20ĀŗC)
Gas density: 0.59 (air = 1)
Water solubility: 33.1% at 68ĀŗF
(20ĀŗC)
Autoignition temperature: 1,204ĀŗF
(650ĀŗC)
Flammable range: 16-25% (concentration
in air) Combustible gas, but difficult to burn
Incompatibilities
Ammonia reacts with strong oxidizers,
acids, halogens (including chlorine bleach), and salts of
silver, zinc, copper, and other heavy metals. It is corrosive
to copper and galvanized surfaces.
Health Effects
- Ammonia is highly irritating to the eyes and respiratory
tract. Swelling and narrowing of the throat and bronchi,
coughing, and an accumulation of fluid in the lungs can
occur.
- Ammonia causes rapid onset of a burning sensation in the
eyes, nose, and throat, accompanied by lacrimation, rhinorrhea,
and coughing. Upper airway swelling and pulmonary edema
may lead to airway obstruction.
- Prolonged skin contact is prolonged (more than a few minutes)
can cause pain and corrosive injury.
Acute Exposure
Anhydrous ammonia reacts with moisture
in the mucous membranes to produce an alkaline solution (ammonium
hydroxide). Exposure to ammonia gas or ammonium hydroxide
can result in corrosive injury to the mucous membranes of
the eyes, lungs, and gastrointestinal tract and to the skin
due to the alkaline pH and the hygroscopic nature of ammonia.
Respiratory
The extent of injury produced by exposure
to ammonia depends on the duration of the exposure, the concentration
of the gas, and the depth of inhalation. Even fairly low airborne
concentrations (50 ppm) of ammonia produce rapid onset of
eye, nose, and throat irritation; coughing; and narrowing
of the bronchi. More severe clinical signs include immediate
narrowing of the throat and swelling, causing upper airway
obstruction and accumulation of fluid in the lungs. This may
result in low blood oxygen levels and an altered mental status.
Mucosal burns to the tracheobronchial tree can also occur.
Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. Children may also be more vulnerable because of failure
to evacuate an area promptly when exposed.
Dermal
Dilute aqueous solutions (less than 5%)
rarely cause serious burns but can be moderately irritating.
Exposure to concentrated vapor or solution can cause pain,
inflammation, blisters, necrosis and deep penetrating burns,
especially on moist skin areas. Skin contact with compressed,
liquid ammonia (which is stored at -28ĀŗF) causes frostbite
injury, and may also result in severe burns with deep ulcerations.
Ocular
Ammonia has a greater tendency to penetrate
and damage the eyes than does any other alkali. Even low concentrations
of ammonia vapor (100 ppm) produce rapid onset of eye irritation.
Contact with high concentrations of the gas or with concentrated
ammonium hydroxide may cause swelling and sloughing of the
surface cells of the eye, which may result in temporary or
permanent blindness.
Gastrointestinal
Nausea, vomiting, and abdominal pain
are common symptoms following ingestion of ammonia. On rare
occasions, deliberate ingestion of household ammonia (5-10%)
has resulted in severe esophageal burns. Ingestion of more
concentrated ammonia can cause severe corrosive injury to
the mouth, throat, esophagus and stomach.
Potential Sequelae
Survivors of severe inhalation injury
may suffer residual chronic lung disease. In cases of eye
contact, ulceration and perforation of the cornea can occur
after weeks or months, and blindness may ensue. Cataracts
and glaucoma have been reported in persons acutely exposed.
Ingestion of ammonia may cause permanent damage to the mucous
membranes of the alimentary canal, with bleeding, perforation,
scarring, or stricture formation as potential sequelae.
Chronic Exposure
Repeated exposure to ammonia may cause
chronic irritation of the respiratory tract. Chronic cough,
asthma and lung fibrosis have been reported. Chronic irritation
of the eye membranes and dermatitis have also been reported.
Carcinogenicity
Ammonia has not been classified for carcinogenic
effects.
Reproductive and Developmental Effects
No data exist to evaluate the reproductive
and developmental effects of ammonia in humans. Ammonia is
not included in Reproductive and Developmental Toxicants,
a 1991 report published by the U.S. General Accounting Office
(GAO) that lists 30 chemicals of concern because of widely
acknowledged reproductive and developmental consequences.
Decreased egg production and conception rates have been observed
in animals, and ammonia has been shown to cross the ovine
placental barrier.
Prehospital Management
- Victims exposed only to ammonia gas do not pose substantial
risks of secondary contamination to personnel outside the
Hot Zone. Victims whose clothing or skin is contaminated
with liquid ammonium hydroxide can secondarily contaminate
response personnel by direct contact or through off-gassing
ammonia vapor.
- Ammonia causes rapid onset of a burning sensation in the
eyes, nose, and throat, accompanied by lacrimation, rhinorrhea,
and coughing. Upper airway swelling and pulmonary edema
may lead to airway obstruction.
- Ammonia gas or solution can cause serious corrosive burns
on contact.
- There is no antidote for ammonia poisoning. Treatment
consists of supportive measures. These include administration
of humidified oxygen and bronchodilators and airway management;
treatment of skin and eyes with copious irrigation; and
dilution of ingested ammonia with milk or water.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Ammonia is a caustic and corrosive chemical
that causes irritation and chemical burns upon contact of
the gas or liquid with the eyes, skin, respiratory tract,
or alimentary canal.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of ammonia.
Skin Protection: Chemical-protective
clothing is recommended because ammonia can cause skin irritation
and burns.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
Victims exposed only to ammonia gas who
have no skin or eye irritation do not need decontamination.
They may be transferred immediately to the Support Zone. All
others require decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe (<20 ppm), decontamination may be conducted by
personnel wearing a lower level of protection than that worn
in the Hot Zone (described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Rapid skin and eye decontamination
is critical. Victims who are able, may assist with their
own decontamination. Remove contaminated clothing while flushing
exposed areas. Double-bag contaminated clothing and personal
belongings.
Flush liquid-exposed skin and hair with
water for at least 5 minutes. If feasible, wash exposed skin
extremely thoroughly with soap and water. Use caution to avoid
hypothermia when decontaminating of children or the elderly.
Use blankets when appropriate.
Irrigate exposed or irritated eyes with
plain water or saline for at least 15 minutes. Remove contact
lenses, if easily removable without additional trauma to the
eye. Continue irrigation while transferring the victim to
the Support Zone.
In cases of ingestion do not induce
emesis, perform gastric lavage, or attempt neutralization.
Do not administer activated charcoal. Victims who are
conscious and able to swallow should be given 4 to 8 ounces
of water or milk.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination or have been exposed only
to vapor pose no serious risks of secondary contamination.
Support Zone personnel require no specialized protective gear
in such cases.
ABC Reminders
Quickly access a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible. Ensure adequate respiration
and pulse; administer supplemental oxygen as required. Establish
intravenous access if necessary. Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate. In cases of ingestion, do not induce
emesis, do not administer activated charcoal, and do not attempt
to neutralize with weak acids. If the patient is conscious
and able to swallow, administer 4 to 8 ounces of water or
milk if it has not been given previously.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so. Patients who are hypotensive or have seizures should
be treated according to advanced life support (ALS) protocols.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Also consider the health of the myocardium
before choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Ammonia poisoning is not known to pose additional
risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or have cardiac arrhythmias should
be treated according to ALS protocols.
Monitor fluid and electrolyte balance
and restore if abnormal. Fluids should be administered cautiously
to patients with pulmonary edema.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If ammonia has been ingested, prepare
the ambulance in case the victim vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
The following exposed persons should
be evaluated at a medical facility: those who have ingested
ammonia, those who have persistent upper respiratory irritation
or other acute symptoms of severe inhalation exposure, and
those who have eye or skin burns that cover a large surface
area.
Persons who have been exposed only to
ammonia gas and are currently asymptomatic are not likely
to develop complications. After their names, addresses, and
telephone numbers are recorded, these patients may be released
from the scene with follow-up instructions to seek medical
care promptly if symptoms develop (see Patient Information
Sheet below).
Emergency Department Management
- Hospital personnel in an enclosed area can be secondarily
contaminated by vapor off-gassing from heavily soaked clothing
or from the vomitus of victims who have ingested ammonia.
Patients do not pose a contamination risk after contaminated
clothing is removed and the skin and hair are washed.
- Inhaling ammonia causes rapid onset of a burning sensation
in the eyes, nose, and throat, accompanied by lacrimation,
rhinorrhea, and coughing. Upper airway swelling may lead
to airway obstruction.
- Ammonia gas or solution can cause serious corrosive burns
on contact.
- There is no antidote for ammonia poisoning. Treatment
consists of support of respiratory and cardiovascular functions.
Decontamination Area
Previously decontaminated patients and
patients exposed only to ammonia gas who have no skin or eye
irritation may be transferred immediately to the Critical
Care Area. Other patients will require rapid decontamination
as described in Basic Decontamination below.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Because of their larger surface area:weight
ratio, children are more vulnerable to toxicants absorbed
through the skin. Also, emergency room personnel should examine
children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. Watch for signs of laryngeal edema and airway
compromise. Children may be more vulnerable to corrosive agents
than adults because of the smaller diameter of their airways.
In cases of respiratory compromise, secure airway and respiration
via endotracheal intubation. If not possible, surgically secure
an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Also consider the health of the myocardium
before choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Ammonia poisoning is not known to pose additional
risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Patients who are comatose, hypotensive
or have seizures should be treated in the conventional manner.
Manage hypotension and shock with intravenous fluids (use
caution when pulmonary edema is present); pressor agents may
be required.
Basic Decontamination
Patients who are able, may assist with
their own decontamination. Remove and double bag contaminated
clothing and personal belongings.
Because ammonia in solution can cause
burns, ED staff should don chemical-resistant jumpsuits (e.g.,
of Tyvek or Saranex) or butyl rubber aprons, rubber gloves,
and eye protection if the patient's clothing or skin is wet.
After the patient has been decontaminated, no special protective
clothing or equipment is required for ED personnel.
Flush liquid-exposed skin and hair with
water for at least 5 minutes. If feasible, wash exposed skin
extremely thoroughly with soap and water.
Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Irrigate exposed or irritated eyes with
plain water or saline for at least 15 minutes. Remove contact
lenses, if easily removable without additional trauma to the
eye. Continue irrigation while transferring the victim to
the Critical Care Area. An ophthalmic anesthetic, such as
0.5% tetracaine, may be necessary to alleviate blepharospasm,
and lid retractors may be required to allow adequate irrigation
under the eyelid.
In cases of ingestion, do not induce
emesis; do not administer activated charcoal. If the patient
is conscious and able to swallow, administer 4 to 8 ounces
of water or milk if it has not been given previously (see
Critical Care Area below for more information on ingestion
exposure).
Critical Care Area
Be certain that appropriate decontamination
has been carried out. (See Decontamination Area above.)
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children may be
more vulnerable to corrosive agents than adults because of
the smaller diameter of their airways. Establish intravenous
access in seriously ill patients if this has not been done
previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive,
having seizures or have cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Also consider
the health of the myocardium before choosing which type of
bronchodilator should be administered. Cardiac sensitizing
agents may be appropriate; however, the use of cardiac sensitizing
agents after exposure to certain chemicals may pose enhanced
risk of cardiac arrhythmias (especially in the elderly). Ammonia
poisoning is not known to pose additional risk during the
use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Observe patients carefully for 6 to 12
hours for signs of upper-airway obstruction. Patients who
have had a severe exposure may develop noncardiogenic pulmonary
edema.
Skin Exposure
If ammonia gas or solution was in contact
with the skin, chemical burns may result; treat as thermal
burns.
Eye Exposure
Continue irrigation for at least 15 minutes
or until the pH of the conjunctival fluid has returned to
normal. Test visual acuity. Examine the eyes for corneal damage
and treat appropriately. Immediately consult an ophthalmologist
for patients who have severe corneal injuries.
Ingestion Exposure
Do not induce emesis because this
may re-expose the esophagus and mouth to the caustic substance.
Do not administer activated charcoal. Do not perform gastric
lavage or attempt neutralization after ingestion. If not given
during decontamination, give 4 to 8 ounces of water by mouth
to dilute stomach contents.
Consider endoscopy to evaluate the extent
of gastrointestinal-tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyroidotomy.
Antidotes and Other Treatments
There is no specific antidote for ammonia
poisoning. Although administration of corticosteroids to limit
esophageal scarring is recommended by some toxicologists,
this treatment is unproven and may be harmful in patients
who have perforation or serious infection. Hemodialysis is
not effective.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Chest radiography and pulse oximetry (or arterial blood gases
measurements) are recommended for severe inhalation exposure
or if pulmonary aspiration is suspected. No specific biologic
test for ammonia exposure exists.
Disposition and Follow-up
Consider hospitalizing patients who have
evidence of respiratory distress or significant skin burns
or who have ingested an ammonia solution.
Delayed Effects
Pulmonary injury may continue to evolve
over 18 to 24 hours. Residual bronchoconstriction, bronchiectasis
and small airway disease may occur, and chronic obstructive
pulmonary disease can develop. Patients exposed by inhalation
who are initially symptomatic should be observed carefully
and reexamined periodically. Pulmonary function tests should
be repeated on an annual basis. Patients who develop pulmonary
edema should be admitted to an intensive care unit.
Acute ocular exposure to ammonia may
result in persistent intraocular pressure, cataract formation,
and glaucoma with significant reduction in visual acuity.
Patient Release
Patients who are asymptomatic following
exposure or who experienced mild symptoms that have been treated
may be released and advised to seek medical care promptly
if symptoms recur or develop (see Ammonia-Patient Information
Sheet below). Cigarette smoking may exacerbate pulmonary
injury and should be discouraged for 72 hours after exposure.
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Patients with mild to moderate skin burns
should be reexamined within 24 hours.
Patients who have eye injuries should
be reexamined by an ophthalmologist in 24 hours.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; note incident
details and contact your state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
ammonia gas or ammonium hydroxide solution.
Print this handout only. pdf icon[PDF - 35 KB]
What is ammonia?
Ammonia is a colorless, highly irritating
gas with a sharp, suffocating odor. It easily dissolves in
water to form a caustic solution called ammonium hydroxide.
It is not highly flammable, but containers of ammonia may
explode when exposed to high heat. About 80% of the ammonia
produced is used in fertilizers. It is also used as a refrigerant
and in the manufacture of plastics, explosives, pesticides,
and other chemicals. It is found in many household and industrial-strength
cleaning solutions.
What immediate
health effects can result from ammonia exposure?
Most people are exposed to ammonia from
breathing the gas. They will notice the pungent odor and experience
burning of the eyes, nose, and throat after breathing even
small amounts. With higher doses, coughing or choking may
occur. Exposure to high levels of ammonia can cause death
from a swollen throat or from chemical burns to the lungs.
Skin contact with ammonia-containing liquids may cause burns.
Eye exposure to concentrated gas or liquid can cause serious
corneal burns or blindness. Drinking a concentrated ammonia
solution can cause burns to the mouth, throat, and stomach.
Generally, the severity of symptoms depends on the degree
of exposure.
Can ammonia poisoning
be treated?
There is no antidote for ammonia poisoning,
but ammonia's effects can be treated, and most people recover.
Persons who have experienced serious signs and symptoms (such
as severe or persistent coughing or burns in the throat) may
need to be hospitalized.
Are any future
health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a severe exposure, injury to the
eyes, lungs, skin, or digestive system may continue to develop
for 18 to 24 hours, and serious delayed effects, such as gastric
perforation, chronic pulmonary obstructive disease, or glaucoma,
are possible.
What tests can
be done if a person has been exposed to ammonia?
Specific tests for the presence of ammonia
in blood or urine generally are not useful to the doctor.
If a severe exposure has occurred, blood and urine analyses,
chest x-rays, and other tests may show whether the lungs have
been injured. Testing is not needed in every case. If ammonia
contacts the eyes, the doctor may put a special dye in the
eyes and examine them with a magnifying lamp.
Where can more
information about ammonia be found?
More information about ammonia can be
obtained from your regional poison control center; your state,
county, or local health department; the Agency for Toxic Substances
and Disease Registry (ATSDR); your doctor; or a clinic in
your area that specializes in occupational or environmental
health. If the exposure happened at work, you may wish to
discuss it with your employer, the Occupational Safety and
Health Administration (OSHA), or the National Institute for
Occupational Safety and Health (NIOSH). Ask the person who
gave you this form for help in locating these telephone numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only. pdf icon[PDF - 35 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing
- difficulty breathing or shortness of breath
- wheezing or high-pitched voice
- chest pain or tightness
- increased pain or a discharge from exposed eyes
- increased redness or pain or a pus-like discharge in the
area of a skin burn
- stomach pain or vomiting
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.