Ammonia Toxicity Follow-up

  • Author: Steven Issley, MD, FRCPC; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jun 27, 2011
 

Further Inpatient Care

The majority of patients with unintentional household ammonia exposure will have very mild symptoms and could be discharged safely if asymptomatic and able to tolerate oral intake.

Admit patients to observation for at least 24 hours if they show significant and persistent signs, symptoms, or abnormalities in laboratory findings attributable to ammonia exposure.

Admit unstable or potentially unstable patients to the intensive care unit.

Following ingestion, patients may be discharged if endoscopy results are normal and oral intake is tolerated.

Intentional ingestions require psychiatric evaluation.

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Complications

Patients can develop chronic respiratory sequelae, particularly with severe ammonia exposures. In a case series by Close et al, exposed patients experienced gradual deterioration of pulmonary function during the first 2-6 months following exposure.[7] A period of slight improvement was then observed, followed by stabilization of symptoms.

Long-term effects of ammonia inhalation injury include the following:

  • Cough
  • Hoarseness
  • Obstructive and/or restrictive lung disease
  • Hyper-reactive airway disease and reactive airway dysfunction syndrome (RADS)
  • Impaired gas exchange
  • Residual parenchymal damage
  • Bronchiectasis and bronchiolitis obliterans (following massive exposure)
  • Pulmonary fibrosis

It is postulated that chronic obstructive disease is secondary to airway lesions more than hyper-reactivity and, therefore, often minimally improved by bronchodilators.

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Prognosis

Most individuals with ammonia inhalation who survive the first 24 hours will recover.

Patients begin showing improvement within 48-72 hours and may recover fully during this time if exposure was mild.

For patients with more significant respiratory symptoms, recovery can be expected within several weeks to months.

Interestingly, Arwood et al found that initial chest x-ray and PaO2 poorly correlate with outcome and that physical examination on arrival is a more sensitive prognosticating factor.[8]

Montague and MacNeil, however, note that patients who do not develop chest x-ray findings are less likely to have chronic respiratory sequelae.[9]

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Patient Education

For excellent patient education resources, visit eMedicine's Burns Center. Also, see eMedicine's patient education article Thermal (Heat or Fire) Burns.

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Contributor Information and Disclosures
Author

Steven Issley, MD, FRCPC  Attending Physician, Trauma Team Leader, Department of Emergency Medicine, Hotel Dieu Grace Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Edmond A Hooker II, MD, DrPH, FAAEM  Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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