Ammonia

CAS RN: 7664-41-7

Treatment in the Hot Zone

Syringe

Treatment

Antidotes - there are no specific antidotes for ammonia.

Supportive

Intubate the trachea in cases of coma or respiratory compromise (avoid blind nasotracheal intubation or use of an esophageal obturator). Use Bag Valve Mask (BVM) if unable to secure airway). If upper airway is obstructed perform cricothyroidotomy or place 14 gauge angiocatheter in crico-thyroid membrane (if equipped and trained to do so). Frequent suctioning of the airways may be necessary to remove mucous secretions.

Link - placement of 14 gauge angiocatheter in cricothryroid membrane

Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Ammonia poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.

Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25 - 0.75 mL of 2.25 % racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.

Patients who are comatose, hypotensive, or are having seizures or cardiac arrhythmias should be treated according to advanced life support (ALS) protocols.

If ammonia was swallowed, immediately give the person water or milk, unless instructed otherwise by the Emergency Department or Poison Control. DO NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow. The addition of water or milk following the ingestion of a large amount of industrial strength ammonia will have no therapeutic benefit. DO NOT place a nasogastric tube.

Frostbite - Always handle frostbitten skin and eyes with caution. Place frostbitten skin in warm water (108 degrees). Do not allow the skin to touch the sides of the container. If hot water is not available wrap the affected area gently in warm blankets. Encourage exercise of the affected part while it is being warmed.

Not FDA approved for this indication/Off-label use

Find more information on this substance at: PubChem, PubMed