Ammonium hydroxide poisoning
Ammonium hydroxide is a colorless liquid chemical solution. It is in a class of substances called caustics. Ammonium hydroxide forms when ammonia dissolves in water. This article discusses poisoning from ammonium hydroxide.
This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.
Aqueous - ammonia
Ammonium hydroxide is poisonous.
Ammonium hydroxide is found in many industrial products and cleaners. Some of these are 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.
Other products may also contain ammonium hydroxide and ammonia.
Below are symptoms of ammonia poisoning in different parts of the body.
AIRWAYS AND LUNGS
- Breathing difficulty (if the ammonia is inhaled)
- Throat swelling (can also cause breathing difficulty)
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
- 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)
- Holes in skin tissue
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, give them milk or water right away. You may also give them fruit juice. But, DO NOT give anything to drink if they have symptoms that make it hard to swallow. These include vomiting, convulsions, or a decreased level of alertness.
If the person breathed in fumes, move them to fresh air right away.
Before Calling Emergency
Have this information ready:
- The person's age, weight, and condition
- The name of the product (ingredients and strength, if known)
- The time it was inhaled, swallowed, or touched the skin
- The amount inhaled, swallowed, or on the skin
Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. 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.
What to Expect at the Emergency Room
Take the container with you to the hospital, if possible.
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 support, including tube through the mouth into the lungs, and breathing machine (ventilator)
- Blood and urine tests
- Bronchoscopy -- camera down the throat to view burns in the airways and lungs
- Chest x-ray
- ECG (electrocardiogram, or heart tracing)
- Endoscopy -- camera down the throat to view burns in the esophagus and the stomach
- Fluids through the vein (IV)
- Medicines to treat symptoms
- Surgery to remove burned skin
- Washing of the skin (irrigation), sometimes every few hours for several days
Some people may need to stay in the hospital overnight.
Survival past 48 hours usually means the person will recover. If the chemical burned their eye, permanent blindness will probably occur in that eye.
How well a person does depends on the strength of the chemical and how fast it was diluted and neutralized. Extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible.
The ultimate outcome depends on how severe the damage is. If the chemical was swallowed, damage to the esophagus and stomach continues to occur for several weeks. Infection may result, and surgery may be needed. Some people won't recover and death can occur weeks or months later.
Keep all cleaning materials, caustics, and poisons in their original containers and out of reach of children.
Fulton JA. Caustics. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, eds. Goldfrank's Toxicologic Emergencies. 10th ed. New York, NY: McGraw Hill-Medical; 2015:chap 106.
Hoyte C. Caustics. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 148.
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.