Anhydrous ammonia burns case report and review of the literature

Chemical burns ale associated with significant morbidity, especially anhydr ous ammonia burns. Anhydrous ammonia is a colorless, pungent gas that is st ored and transported under pressure in liquid form. A 28 year-old patient s uffered 45% total body surface al ea of second and third degree burns as we ll as inhalational injury from an anhydrous ammonia explosion. Along with f luid resuscitation, the patient's body was scrubbed every 6 h with sterile water for the first 48 h to decrease the skin pH from 10 to 6-8. He subsequ ently underwent a total of seven wound debridements; initially with allogra ft and then autograft. On post burn day 45, he was discharged. The injuries associated with anhydrous ammonia burns are specific to the effects of amm onium hydroxide. Severity of symptoms and tissue damage produced is directl y related to the concentration of hydroxyl ions. Liquefactive necrosis resu lts in superficial to full-thickness tissue loss. The affinity of anhydrous ammonia and its byproducts for mucous membranes can result in hemoptysis, pharyngitis, pulmonary edema, and bronchiectasis. Ocular sequelae include i ritis, glaucoma, cataracts, and retinal atrophy. The desirability of treati ng anhydrous ammonia burns immediately cannot be overemphasized. Clothing m ust be removed quickly, and irrigation with water initialed at the scene an d continued for the first 24 h, Resuscitative measures should be started as well as early debridement of nonviable skin. Patients with significant fac ial or pharyngeal burns should be intubated, and the eyes irrigated until a conjunctivae sac pH below 8.5 is achieved. Although health care profession als need to be prepared to treat chemical burns, educating the public, espe cially those workers in the agricultural and industrial setting, should be the first line of prevention. (C) 2000 Elsevier Science Ltd and ISBI. All r ights reserved.