Ammonia Intoxication at the Work Place - A Case Report

Abstract

Objectives:We report a case of intoxication with irritant vapors (ammonia). Methods: The patient was admitted to the Occupational Diseases Compartment of the Sibiu Clinical County Hospital, Romania, monthly-in January, February, March, April in 2015, for respiratory symptomatology, which was initially included in the manifestations of the intoxication with irritant vapors, later for the chronic post-intoxication residual respiratory effects. Results: The patient, though young (36 years old), is now retired on medical ground, because of the pulmonary complications which occurred despite the intensive treatment. Discussion: The intoxication occurred because of a work accident at a preserved meat product factory in the city. We emphasize the importance of preventing such situations.

A multidisciplinary approach to accidental inhalational ammonia injury: A case report

“…Severe acute exposure to ammonia gas may cause significant damage to respiratory tissues which may be fatal or lead to severe pulmonary impairment often requiring mechanical ventilatory assistance to rarely needing lung transplantation [ 1 , 2 ]. Our patient did not require such measures despite severe injuries resulting from the prolonged inhalation exposure and managed with supportive and symptomatic treatment including nebulized glucocorticoids and prophylactic antibiotic therapy to prevent secondary bacterial infection.…”

“…Our patient initially showed some improvement but there was some deterioration on the third day which subsequently improved after additional antibiotics indicating that superinfection infection should be considered and managed accordingly in such cases. Similarly, a case reported by Maries et al developed irritation syndrome of the upper airways, occlusive bronchiolitis, and acute toxic pulmonary edema and managed symptomatically including steroids and prophylactic antibiotics, and did not require ventilatory assistance [ 2 ]. While cases reported by Köksal et al [ 11 ] and Lalić et al [ 12 ] required mechanical ventilation and lung transplantation respectively.…”

“…Ammonia is a colorless pungent odor highly water soluble irritant gas producing ammonium ion in water [ 1 , 2 ]. Ammonia is synthesized de-novo within the body as part of many biochemical reactions including bacterial enzymatic activities and is quickly metabolized to non-toxic urea by the liver and excreted by kidneys to neutralize its high toxicity effect.…”

“…The normal blood level of ammonia in a healthy adult is in the range of 15–45 μg/dL and its toxicity occurs once its blood level surpasses the liver's ability to detoxify it [ 3 ]. Ammonia exposure occurs from occupational ammonia gas exposure like in production storage, transportation facilities, exposure to ammonia-based fertilizers, household and industrial cleaners, cooling refrigerants, decaying manure via ingestion, inhalation, direct contact with skin, or contact with the eye [ 1 , 2 ]. As per the annual report of the American Association of Poison Control Centre National Poison Data system annual report of the American Association of Poison Control Center's National Poison Data System, there were 1846 single exposures to ammonia with 15 major events and no mortality in 2017 [ 4 ].…”

“…So, exposure to ammonia gas can damage eyes, skin, lungs, and gastrointestinal tract causing mucosal injuries, scarring, and even perforation. The presentation of a patient varies with acute vs chronic intoxication, causing tracheobronchitis, asphyxiation, and even death on acute exposure and bronchiectasis, optic neuropathy on chronic exposure via inhalation [ 1 , 2 , 6 , 7 ]. Its diagnosis is done based on circumstances of possible exposure, physical examination findings, and basic and body system-focused lab tests while there are no tests for assessing the extent of its toxicity [ 1 ].…”