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Ammonium hydroxide poisoning

Ammonium hydroxide is a colorless liquid chemical solution that forms when ammonia dissolves in water. This article discusses poisoning due to ammonium hydroxide.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or a local poison control center at 1-800-222-1222.

Alternative Names

Aqueous - ammonia

Poisonous Ingredient

Ammonium hydroxide

Where Found

Ammonium hydroxide is found in many industrial products and cleaners such as flooring strippers, brick cleaners, and cements.

Ammonium hydroxide can also release ammonia gas into the air.

Ammonia alone (not ammonium hydroxide) can be found in many household items such as detergents, stain removers, bleaches, and dyes. The symptoms and treatment for ammonia exposure are similar to those for ammonium hydroxide.

Note: This list may not be all inclusive.

Symptoms

Airways and lungs:

  • Breathing difficulty (from inhalation)
  • Coughing
  • Throat swelling (which may also cause breathing difficulty)
  • Wheezing

Eyes, ears, nose, and throat:

  • Severe pain in the throat
  • Severe pain or burning in the nose, eyes, ears, lips, or tongue
  • Vision loss

Esophagus, stomach, and intestines:

  • Blood in the stool
  • Burns of the esophagus (food pipe) and stomach
  • Severe abdominal pain
  • Vomiting, possibly with blood

Heart and blood:

  • Collapse
  • Low blood pressure (develops rapidly)
  • Severe change in pH (too much or too little acid in the blood, which leads to damage in all of the body organs)

Skin:

  • Burns
  • Holes in skin tissue (necrosis)
  • Irritation

Home Care

Do NOT make the person throw up.

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

If the person swallowed ammonium hydroxide, immediately give milk or water. Fruit juices may also be given. DO NOT give water, juice, 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 person breathed in fumes, immediately move the patient to fresh air.

Before Calling Emergency

Determine the following information:

  • The person's age, weight, and condition
  • The name of the product (ingredients and strengths, if known)
  • The time it was swallowed
  • The amount swallowed

Poison Control

In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. 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.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

The person may receive:

  • Breathing suport, including tube through the mouth into the lungs, and breathing machine (ventilator) 
  • Bronchoscopy -- camera down the throat to see burns in the airways and lungs
  • Chest x-ray
  • EKG (heart tracing)
  • Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
  • Fluids through the vein (by IV)
  • Medicines to treat symptoms
  • Skin debridement (surgical removal of burned skin)
  • Washing of the skin (irrigation) -- perhaps every few hours for several days

Some persons may be admitted to the hospital.

Outlook (Prognosis)

Survival past 48 hours usually indicates recovery will occur. If a chemical burn occurred in the eye, permanent blindness will probably result.

How well a person does depends on the strength of the chemical and how fast the poison was diluted and neutralized. Extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible.

The ultimate outcome depends on the extent of this damage. Damage continues to occur to the esophagus and stomach for several weeks after the poison was swallowed, and death may occur as long as a month or later.

References

Belson M. Ammonia and Nitrogen Oxides. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 97.

Harchelroad FP Jr, Rottinghaus DM. Chemical burns. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 200.

Wax PM, Yarema M. Corrosives. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 98.

Wax PM, Young A. Caustics. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 153.

Updated: 2/7/2014

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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