Acute and long term respiratory damage following inhalation of ammonia.

Abstract

A lifelong non-smoker who was the victim of a massive accidental exposure to anhydrous ammonia gas was followed up for 10 years. In the acute phase the patient presented with severe tracheobronchitis and respiratory failure, caused by very severe burns of the respiratory mucosa. After some improvement he was left with severe and fixed airways obstruction. Isotope studies of mucociliary clearance, computed tomography, and bronchography showed mild bronchiectasis. It is concluded that acute exposure to high concentrations of ammonia may lead to acute respiratory injury but also to long term impairment of respiratory function. (Thorax 1992;47:755-757)

Acute Inhalation Injury

“…Supportive treatment involves bronchodilators, oxygen therapy, and observation for need for airway protection for 6 to 12 hours as well as early intubation, which may be required to defend the airway from acute laryngeal obstruction. Cricothyroidotomy may be required in more severe cases [4,8,[21][22][23].…”

“…Its low odor threshold, however, creates an early warning of its presence. Still, olfactory fatigue or adaptation may occur and render its presence less detectable [4,8,[21][22][23].…”

Acute respiratory effects of exposure to ammonia on healthy subjects

“…The extent of respiratory injury after ammonia inhalation depends on the duration of exposure, the concentration of the gas, and the tidal volume. Acute exposure to high concentrations of ammonia may cause tracheobronchitis with severe airflow obstruction followed by chronic airflow obstruction with bronchiectasis (7,8). It has been suggested that long-term exposure to lower concentrations is associated with sinusitis, mucous membrane inflammation syndrome, chronic bronchitis, and asthma-like symptoms (4).…”

Anhydrous ammonia pulmonary toxicity: A significant farming hazard

“…Pathological findings include fibrous obliteration of small airways consistent with late stage bronchiolitis obliterans which results in the obstructive component of this disease. 13 …”

“…12 Fiberoptic bronchoscopy is helpful for assessment of the inhalational injury as it can reveal erythema, congestion, hemorrhage, and extensive desquamation of the tracheobronchial tree. 13 During the early phase of injury, hypoxemia and acute airway obstruction caused by the sloughing of mucosa pose the greatest threat. When endotracheal intubation is required, the largest possible diameter endotracheal tube should be used because mucosal sloughing may quickly occlude small diameter tubes.…”