Ammonium hydroxide poisoning

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.

Ammonium hydroxide is used in the illegal production of methamphetamine.

Below are symptoms of ammonia exposure or poisoning in different parts of the body.

AIRWAYS AND LUNGS

• Breathing difficulty (if the ammonia is inhaled)
• Coughing
• Throat swelling (can also cause breathing difficulty)
• Wheezing

EYES, EARS, NOSE, AND THROAT

• Inability to swallow
• 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
• Irritation

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.

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.

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

Your health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

You may receive:

• Breathing support, including oxygen, 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)
• Endoscopy -- camera down the throat to view burns in the esophagus and the stomach
• Fluids through a vein (IV)
• Medicines to treat symptoms
• Surgery to remove burned skin (debridement)
• Washing of the skin (irrigation), sometimes every few hours for several days

You 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 and holes (perforation) 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.

Aqueous - ammonia

Cohen DE. Irritant contact dermatitis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 15.

Hoyte C. Caustics. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 143.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.