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Ammonia poisoning

Definition

Ammonia is a strong, colorless gas. If the gas is dissolved in water, it is called liquid ammonia. Poisoning may occur if you breathe in ammonia. Poisoning may also occur if you swallow or touch products that contain very large amounts of ammonia.

WARNING: Never mix ammonia with bleach. This causes the release of toxic chlorine gas, which can be deadly.

This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

The poisonous ingredient is:

Ammonia

Where Found

Ammonia can be found in:

Ammonia gas
Some household cleaners
Some liniments
Some fertilizers

Note: This list may not be all-inclusive.

Symptoms

Symptoms can affect many parts of the body.

AIRWAYS, LUNGS, AND CHEST

Cough
Chest pain (severe)
Chest tightness
Difficulty breathing
Rapid breathing
Wheezing

BODY-WIDE SYMPTOMS

Fever

EYES, EARS, NOSE, MOUTH, AND THROAT

Tearing and burning of eyes
Temporary blindness
Throat pain (severe)
Mouth pain
Lip swelling

HEART AND BLOOD

Rapid, weak pulse
Collapse and shock

NERVOUS SYSTEM

Confusion
Difficulty walking
Dizziness
Lack of coordination
Restlessness
Stupor (altered level of consciousness)

SKIN

Bluish-colored lips and fingernails
Severe burns if contact is longer than a few minutes

STOMACH AND GASTROINTESTINAL TRACT

Severe stomach pain
Vomiting

Home Care

DO NOT make a person throw up unless told to do so by poison control or a health care professional. Seek immediate medical help.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, immediately give the person water or milk, unless told otherwise by a health care provider. DO NOT give water or milk if the person is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

If the poison was inhaled, immediately move them to fresh air.

Before Calling Emergency

Determine the following information:

Person's age, weight, and condition
Name of product (as well as the ingredients and strengths, if known)
Time it was swallowed
Amount swallowed

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Blood and urine tests will be done. The person may receive:

Airway and breathing support, including oxygen. In extreme cases, a tube may be passed through the mouth into the lungs to prevent aspiration. A breathing machine (ventilator) would then be needed.
Bronchoscopy, which involves inserting a camera into the throat, bronchial tubes, and lungs to check for burns in those tissues.
Chest x-ray.
ECG (electrocardiogram, or heart tracing).
Endoscopy - a camera down the throat to see burns in the esophagus and stomach.
Fluids through a vein (by IV).
Medicines to treat symptoms.

Outlook (Prognosis)

Damage is related to the amount and strength (concentration) of the ammonia. Most household cleaners are relatively weak and cause little or mild damage. Industrial strength cleaners can cause severe burns and injury.

Survival past 48 hours most often indicates recovery will occur. Chemical burns that occurred in the eye frequently heal; however, permanent blindness may result.

References

Levine MD. Chemical injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 55.

Meadon CW, Nelson LS. Inhaled toxins. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 148.

Meehan TJ. Care of the poisoned patient. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 135.

Schedule An Appointment

Review Date: 10/6/2022

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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