Causes
Ammonia poisoning is mainly seen in the production and manufacture of ammonia, transportation, storage, use, such as pipelines, valves, storage tanks and other damage, leakage leakage caused. Rarely seen in the accidental intake of ammonia.
Clinical manifestations
1. Irritation reaction
Only transient eye and upper respiratory tract irritation, no obvious positive signs in the lungs.
2. Mild poisoning
Inhalation of more ammonia, there may be tearing, sore throat, hoarseness, cough, sputum, etc., and may be accompanied by mild dizziness, headache, fatigue, etc., conjunctiva, nasal mucosa, pharyngeal congestion and edema, and dry rales in the lungs;
3. Moderate poisoning
Immediately after inhalation of high concentration of ammonia, there is burning pain in the pharynx, hoarseness, violent cough, coughing up sputum, sometimes accompanied by bloody sputum; chest tightness, dyspnea, often accompanied by dizziness, headache, nausea, vomiting, loss of appetite and fatigue, etc., conjunctiva and pharynx are obviously congested and edematous, and there may be edema of the larynx, frequent respiration, mild cyanosis. There are dry and wet rales in the lungs.
4. Severe poisoning
After inhaling high concentration of ammonia for a long time, there are frequent violent cough, coughing a lot of pink foamy sputum, sometimes gushing out from the nostrils; at the same time, there are chest tightness, dyspnea and other manifestations. Pulmonary edema appears early, the shortest time is 15 minutes, usually in 1-6 hours, individual cases of pulmonary edema 30 hours after poisoning, and often accompanied by laryngeal edema, palpitation, irritability, nausea, vomiting or delirium, coma, shock, and also myocarditis or heart failure. Three to seven days after poisoning, trachea, bronchial mucosa necrosis, detachment, in the form of blocks, strips, some were dendritic, the same patient can intermittently several times clucked out necrotic detachment of the trachea or bronchial mucosa. Often complicated by secondary infection, body temperature increases. Oral and pharyngeal mucosa congestion, edema, erosion, white pseudomembrane formation, respiratory distress, obvious cyanosis. Both lungs are full of dry and wet rales.
Eye contact with liquid ammonia or high concentration of ammonia can cause burns, and corneal perforation can occur in severe cases. Skin contact with liquid ammonia can cause burns.
Treatment
1. The treatment of ammonia poisoning is based on supportive therapy, and the key is to maintain the oxygenation of the body.
2. Immediately move the patient away from the scene of poisoning, and remove contaminated clothing, pay attention to keep warm. Give oxygen, artificial respiration and inject respiratory stimulant.
3. Keep the respiratory tract open. For patients with laryngeal edema, respiratory burns and respiratory distress, consider tracheotomy as soon as possible. Prepare sputum aspirator. If there is no incision instrument, cricothyroid puncture can be done. At the same time, give valium, aminophylline, hydrocortisone, gentamicin and other drugs to relieve spasm, keep the respiratory tract open, promote sputum discharge, reduce pulmonary edema and control infection. In mild cases, 3% boric acid can be applied for nebulized inhalation.
4. Prevention and treatment of pulmonary edema. Use glucocorticosteroids in short-term and full dosage; control the amount of fluid, appropriate diuresis, reduce pulmonary edema.
5. Maintain oxygenation. Including nasal cannula oxygen, mask oxygen, etc., if necessary, use positive pressure ventilation. Oxygenation to maintain the target oxygen saturation of 93% or more.
6. For eye burns, immediately rinse repeatedly with water or 3% boric acid solution for at least 15 minutes, then, give chloramphenicol ophthalmic solution or other antibiotic ointment every 2 to 4 hours. If iritis occurs, 1% atropine solution can be used for eye drops. If ocular edema is obvious, cortisone eye drops can be used alternately with antibiotic eye.
7. For skin burns, immediately rinse the skin with water, 3% boric acid solution, 2% acetic acid solution, or vinegar to neutralize the ammonia and eliminate the burning. If the skin has blisters, oozing, ulcers, use 2% boric acid wet compresses and chemical burn oil external application. Specialized treatment is required for large and deep burns.
Post time: Oct-09-2024