The poisonous ingredient is:

• Ammonia

Ammonia can be found in:

• Ammonia gas
• Some household cleaners
• Some liniments
• Some fertilizers

Note: This list may not be all-inclusive.

Symptoms can affect many parts of the body.

AIRWAYS, LUNGS, AND CHEST

• Cough
• Chest pain (severe)
• Chest tightness
• Difficulty breathing
• Rapid breathing
• Wheezing

BODY-WIDE SYMPTOMS

• Fever

EYES, EARS, NOSE, MOUTH, AND THROAT

• Tearing and burning of eyes
• Temporary blindness
• Throat pain (severe)
• Mouth pain
• Lip swelling

HEART AND BLOOD

• Rapid, weak pulse
• Collapse and shock

NERVOUS SYSTEM

• Confusion
• Difficulty walking
• Dizziness
• Lack of coordination
• Restlessness
• Stupor (altered level of consciousness)

SKIN

• Bluish-colored lips and fingernails
• Severe burns if contact is longer than a few minutes

STOMACH AND GASTROINTESTINAL TRACT

• Severe stomach pain
• Vomiting

DO NOT make a person throw up unless told to do so by poison control or a health care professional. Seek immediate medical help.

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

If the chemical was swallowed, immediately give the person water or milk, unless told otherwise by a health care provider. DO NOT give water 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 poison was inhaled, immediately move the person to fresh air.

Determine the following information:

• Person's age, weight, and condition
• Name of product (as well as the ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed

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 number 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.

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Blood and urine tests will be done. The person may receive:

• Airway and breathing support, including oxygen. In extreme cases, a tube may be passed through the mouth into the lungs to prevent aspiration. A breathing machine (ventilator) would then be needed.
• Bronchoscopy, which involves inserting a camera into the throat, bronchial tubes, and lungs to check for burns in those tissues.
• Chest x-ray.
• ECG (electrocardiogram, or heart tracing).
• Endoscopy - a camera down the throat to see burns in the esophagus and stomach.
• Fluids through a vein (by IV).
• Medicines to treat symptoms.

Damage is related to the amount and strength (concentration) of the ammonia. Most household cleaners are relatively weak and cause little or mild damage. Industrial strength cleaners can cause severe burns and injury.

Survival past 48 hours most often indicates recovery will occur. Chemical burns that occurred in the eye frequently heal; however, permanent blindness may result.

Levine MD. Chemical injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 57.

Meehan TJ. Approach to the poisoned patient. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 139.

Nelson LS, Hoffman RS. Inhaled toxins. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 153.

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