Ammonia poisoning: signs, consequences, diagnosis

Ammonia is considered to be one of the most common substances used by the chemical industry. Specific gas is used for the production of fertilizers, colorants, nitric acid, etc. Acute poisoning with ammonia is accompanied by eye and respiratory tract damage, and with a strong concentration, the inhalation of gas can become fatal. Why is this compound so dangerous, and what to do to avoid unpleasant consequences with ammonia intoxication?

[1], [2]

Epidemiology

There are no special statistics on cases of poisoning with ammonia. It is believed that poisoning most often occur on a production scale: in factories that specialize in the manufacture of explosives, paint and varnish coatings, refrigeration units, photoreactives, etc. The main way of penetrating the poison into the body is the upper respiratory tract.

Victims of poisoning with ammonia are more often men. Most likely, this is due to professional characteristics: the above-mentioned dangerous enterprises employ mainly male representatives.

[3], [4], [5], [6], [7],

Causes of the poisoning with ammonia

Intoxication is caused by a colorless gaseous substance ammonia, which has a specific sharp flavor. Liquefied ammonia with a concentration of 25% -30% can be purchased in some stores - it is used as a solvent.

Pure ammonia gas is not used anywhere, because of its toxicity. However, it is actively used on an industrial scale: in the production of varnishes and paints, finishing materials. No less widespread is a medical device, such as ammonia. It is used in a concentration of 10% to restore consciousness in humans, to activate the emetic reflex. Also, doctors sometimes use the ointment form of the drug, in which ammonia is a distraction in the treatment of pain in the muscles, neuritis, etc.

Many soil fertilizers also consist of a certain amount of ammonia. Gas is used in the manufacture of refrigeration units and freezers, in the production of explosives.

A person can very rarely encounter ammonia gas, but when working with ammonia-containing drugs, extreme care and accuracy should always be observed so as not to cause poisoning of the body.

[8], [9], [10], [11], [12]

Risk factors

Ammonia poisoning can occur under the influence of such factors:

• accidents at industries where leakage of gaseous matter occurs (as a rule, in such accidents, there is a massive intoxication damage - both employees of the enterprise, and those who live or are in the vicinity);
• use of ammonia components in everyday life - for example, during repair, or under other circumstances;
• improper use of ammonia fertilizers;
• accidental inhalation or internal use of ammonia solution.

The workers who clean up or check the sewerage systems are not less at risk.

[13], [14], [15], [16], [17], [18], [19]

Pathogenesis

Ammonia is the final substance obtained as a result of protein metabolism, the metabolism of amino acids and nitrogenous compounds.

For living creatures, ammonia is a fairly toxic product. Therefore, most of it during enzymatic transformations in the liver is converted to urea, which is much less toxic. Urea safely leaves the body through the urinary system, but some of it can again be converted to ammonia.

In a living organism, ammonia plays the role of a reducing agent and is used by the liver for the reverse synthesis of amino acids.

Gas in high concentrations or with prolonged exposure can lead to poisoning. The mechanism of this action is directly related to the ability of ammonia to corrode the tissues of the body.

You can get poisoning with ammonia in several ways:

• inhaling the gas;
• through the skin;
• through mucous membranes.

The most common is inhalation intoxication and oral poisoning with ammonia.

Some people mistakenly believe that it is possible to receive poisoning only by concentrated matter. But this is not so: intoxication is possible even when exposed to small doses of ammonia, but for a longer time.

Lethal amount of aqueous solution for oral administration:

• 25-50 ml of 10% solution;
• 15 ml of a 25% solution.

The maximum allowable gas concentration of ammonia in the room should not be above 0.02 mg per liter (20 mg per cubic meter).

[20], [21], [22], [23], [24]

Symptoms of the poisoning with ammonia

Ammonium vapor causes a strong irritation of the mucous membranes of the eyes and respiratory organs, as well as skin. Ammonia causes severe lachrymation, eye pain, chemical damage to conjunctiva right up to loss of vision, coughing attacks, flushing and itching of the skin.

When liquid ammonia enters the skin, burning occurs, sometimes - a chemical burn with the formation of bubbles and ulcers. In addition, liquefied gas absorbs some heat during evaporation, which can lead to frostbite of varying degrees.

A characteristic ammonia smell can be felt at concentrations of 37 mg / mi.

According to the actual effect on the human body, ammonia is referred to as suffocating and neurotropic substances, which, when inhaled, provoke toxic pulmonary edema and severe intoxication of the nervous system.

The first signs of poisoning are detected almost immediately after exposure to gas:

• the appearance of a large amount of mucus in the nasopharynx, a sudden onset of a cold;
• weakening or loss of voice;
• excretion of tears, salivation, sweat secretion;
• frequent breathing, coughing, sneezing;
• redness of the skin (especially on the face);
• a feeling of pressure and heaviness in the chest;
• a feeling of anxiety, fear;
• pain in the chest;
• impaired consciousness, dizziness;
• the urge to vomit;
• convulsions.

Long-term poisoning with ammonia vapor can cause strong weakness in the muscles, a violation of blood circulation. There may be symptoms of impairment from the respiratory system. If the toxic effects are repeated regularly, then there are disorders of a systemic nature: digestive disruptions, chronic upper respiratory tract diseases, persistent hearing impairment. The affected person has swelling, the skin becomes especially sensitive.

Poisoning with ammonia compounds can result in death if the patient shows signs of cardiac insufficiency.

Poisoning with ammonia solution is possible when ingested. In such situations, the solution can cause burn damage to the esophagus and gastric cavity, exotoxic burn shock, gastroesophageal bleeding, mechanical asphyxia due to burns and laryngeal edema. If the victim has taken a highly concentrated ammoniacal liquid inside, a reflex stop of breathing may occur, or reactive peritonitis develops.

Many specialists conduct a conditional separation of clinical symptoms into several degrees, for a more rapid diagnosis:

• The mild poisoning with ammonia is accompanied by mucous discharge from the nose, sneezing, throat swelling, hoarseness or loss of voice, pain behind the sternum. These symptoms are eliminated relatively quickly, subject to the termination of the action of ammonia on the body. As a rule, in a week the doctors fix the clinical recovery of the patient.
• With moderate poisoning with ammonia, the mucous nasal cavity swells and burns are formed on it. The larynx also swells - in particular, it becomes noticeable due to the condition of the epiglottis, arytenoid cartilage, pre-folds.
• At severe poisoning with ammonia, extensive burn lesions of the upper parts of the respiratory system are found: rejection of necrotic tissues is observed. In the cavity of the trachea, fibrinous necrotic formations are formed. In case of severe intoxication, the patient is hospitalized in the hospital for at least 20 days, or more.

Complications and consequences

In addition to serious symptoms of poisoning with ammonia, it is possible to develop long-term effects of intoxication. These include:

• disorders of the functionality of the nervous system, which are manifested by tremors, amnesia, difficulties in intellectual activity, impaired orientation, decreased sensitivity, dizziness;
• impairment of auditory function in cases of toxic agents of hearing;
• deterioration of vision (until its loss).

Even with the provision of timely medical assistance to the victim of ammonia poisoning, complications may occur in the future in the form of neurological disorders, loss of individual situations or information, various tics from memory. Many people have lowered the threshold of pain sensitivity, hearing worsens, clouding of the lens and cornea.

When you use the ammonia solution inside, complications of a different nature develop:

• cicatricial narrowing of the esophagus;
• cicatrical narrowing of the antrum of the stomach;
• late ulcerous bleeding;
• aspiration pneumonia.

[25], [26], [27],

Diagnostics of the poisoning with ammonia

Most often the provoking chemical agent - ammonia - is determined by the type of industrial accident or by other characteristic features. Further, the doctor can prescribe additional diagnostics - first of all, in order to determine the state of the patient's body during poisoning with ammonia.

Analyzes of blood and urine with any intoxication are mandatory. A toxicological study is also conducted to establish the qualitative and quantitative composition of the toxic substance in the biological environment of the body. The use of nonspecific biochemical analyzes makes it possible to determine the negative effect exerted by the toxic substance on the liver, kidneys and other organs of the victim.

Instrumental diagnostics is carried out to obtain information on the state of the cardiovascular system of the victim, on the work of the brain. Priority procedures are:

• electrocardiography;
• Ultrasound of internal organs;
• fluorography.

If necessary, procedures such as echocardiography, electroencephalography, and endoscopy can be prescribed.

[28], [29],

Differential diagnosis

Differential diagnosis is performed with other possible poisonings. Depending on the situation, the doctor can take the following measures:

• check the scene;
• examine the victim's clothes;
• find out the profession and place of work;
• conduct toxic chemical research.

The goal number "one" for poisoning - to determine the cause of this condition, since it is on the root cause that virtually all medical measures are based.

[30], [31], [32]

Treatment of the poisoning with ammonia

Since poisoning with ammonia in many cases can lead to death, treatment should be started as soon as possible. The main thing is to quickly stop the effect of gas on the body.

Prevention

Poisoning with ammonia is much easier to prevent than to treat its consequences in the future. The main condition is compliance with all the rules for safe handling of chemicals. So, when working with varnishes, paints and solvents, it is necessary to wear not only special gloves, but also glasses, and a means to protect the respiratory system.

In case of an industrial emergency, management must take all necessary measures to obligatory evacuate all employees of the enterprise, as well as to block the spread of toxic gas. Evacuation of people should be carried out at a sufficient distance from the emergency ejection zone: if this is not possible, special basement bins should be used with the ventilation system installed in them. The cellar is an adequate place to protect people from the effects of ammonia: since this gas is lighter than air, it accumulates mostly closer to the ceiling and to the upper floors of the room.

[33], [34], [35]

Forecast

The prognosis for ammonia poisoning depends entirely on how much the toxic damage to internal organs turned out to be. If there was intoxication of mild or moderate degree, then the prognosis can be considered favorable, with further complete restoration of the functionality of the organs for 10-25 days.

If there was a serious poisoning with ammonia with the defeat of vital organs, then the recovery process can be delayed up to several months and even years, and in some cases, pathological changes become irreversible.