Treatment of Ammonia Inhalation
The immediate treatment for ammonia inhalation should focus on rapid evacuation from the exposure site, securing airway and breathing, decontamination if possible, and providing supportive care including oxygen therapy and bronchodilators for respiratory symptoms. 1
Initial Management
- Remove the patient from the exposure site immediately to prevent further inhalation of ammonia gas 1
- Secure airway, breathing, and circulation as the first priority in management 1
- Perform decontamination of skin and eyes if there was direct contact with liquid ammonia 2
- Irrigate eyes promptly (within 5-10 seconds) if exposed to ammonia 3
- Administer humidified oxygen to treat hypoxia and respiratory distress 1
Respiratory Management
- Assess for signs of respiratory injury including bronchospasm, pulmonary edema, and hypoxia 1
- Administer bronchodilators for bronchospasm and wheezing 1
- Consider frequent bronchoscopy to assess airway damage and remove debris, which may help avoid intubation and its associated morbidity 2
- Intubate and provide mechanical ventilation for severe respiratory distress or respiratory failure 3
- Monitor oxygen saturation continuously and provide supplemental oxygen as needed 1
Additional Supportive Care
- Provide intravenous fluid resuscitation for hypovolemia, particularly if there are associated cutaneous burns 1
- Treat skin burns according to standard burn protocols 3
- Consider broad-spectrum antibiotics to prevent secondary infections, especially in cases of severe respiratory injury 1
- Consider systemic corticosteroids to reduce inflammation and prevent late-onset complications, although evidence for their efficacy is limited 1
Monitoring and Follow-up
- Monitor for development of pulmonary edema, which may be delayed up to 24 hours after exposure 4
- Perform serial chest radiographs to assess for progression of pulmonary injury 3
- The presence or absence of abnormal chest findings on admission is the best prognostic factor 3
- Be aware that severe ammonia inhalation can lead to long-term respiratory impairment including fixed airways obstruction and bronchiectasis 4
- Long-term follow-up is essential as chronic lung diseases may develop, including restrictive lung dysfunction, obstructive lung disease, and bronchial hyperreactivity 5
Common Pitfalls and Caveats
- Do not delay removal from the exposure site or decontamination procedures 1
- Remember that pulmonary symptoms may be delayed, so observation for at least 24 hours is recommended even if initial symptoms are mild 4
- Avoid assuming complete recovery after initial improvement, as long-term respiratory sequelae are common 5
- Be aware that ammonia causes both thermal and chemical injury to the respiratory tract 3
- Recognize that severe ammonia inhalation carries high morbidity and mortality rates 2