Diseases Caused by Ammonia

1. Introduction and Definitions

Ammonia (NH3) is a colorless gas with a pungent odor, widely used in various industries, including agriculture, refrigeration, and chemical manufacturing. While it is an essential chemical in many processes, exposure to high levels of ammonia can cause significant health problems, particularly affecting the respiratory system, eyes, and skin. This article provides comprehensive information on diseases caused by ammonia, targeting occupational health nurses and doctors.

2. Agent Causes the Disease

Exposure to ammonia occurs primarily through inhalation of its vapors, though it can also be absorbed through dermal contact or ingestion. Ammonia is used in agricultural fertilizers, industrial cleaning products, refrigeration systems, and the production of chemicals such as nitric acid and urea. Its high reactivity makes it a potent irritant, leading to chemical burns and respiratory distress.

3. Workers at Risk of This Disease

Several occupations and tasks put workers at higher risk of exposure to ammonia, including:

  • Agricultural Workers: Using ammonia-based fertilizers.
  • Refrigeration Technicians: Handling ammonia in refrigeration systems.
  • Chemical Manufacturing Workers: Involved in the production of chemicals using ammonia.
  • Cleaning and Maintenance Workers: Using industrial cleaning products containing ammonia.
  • Wastewater Treatment Workers: Managing systems where ammonia is a byproduct.
  • Laboratory Technicians: Using ammonia in research and analytical procedures.

4. Symptoms

Symptoms of diseases caused by ammonia exposure can vary depending on the level and duration of exposure:

  • Acute Exposure: Symptoms include respiratory irritation (coughing, wheezing, shortness of breath), eye irritation (redness, tearing, pain), and skin irritation (redness, itching, burns). High levels of exposure can lead to severe respiratory distress, pulmonary edema, and chemical burns to the skin and eyes.
  • Chronic Exposure: Long-term exposure to lower levels of ammonia can cause chronic bronchitis, asthma-like symptoms, and persistent irritation of the eyes and skin.

5. Diagnosis

Diagnosing diseases caused by ammonia involves a combination of clinical evaluation, occupational exposure assessment, and specific tests:

  • Medical History and Physical Examination: Detailed assessment of the patient's work history and symptoms.
  • Pulmonary Function Tests: To assess lung function and detect any obstructive or restrictive patterns.
  • Chest X-rays or CT Scans: Imaging to detect lung inflammation, fibrosis, or other damage.
  • Blood Gas Analysis: To measure the levels of oxygen and carbon dioxide in the blood, indicating respiratory distress or failure.
  • Skin and Eye Examination: For signs of irritation, burns, or chronic dermatitis.

6. Treatment

Treatment for diseases caused by ammonia focuses on managing symptoms and preventing further exposure:

  • Remove from Exposure: Immediate removal from the source of ammonia exposure is crucial.
  • Symptomatic Treatment: Providing medications to manage respiratory symptoms, such as bronchodilators and corticosteroids, and treatments for skin and eye irritation, such as topical corticosteroids and eye irrigation.
  • Supportive Care: Including hydration, pain management, and monitoring of respiratory and skin health.
  • Emergency Care: In cases of severe exposure, providing oxygen therapy, mechanical ventilation, and intensive care as needed.
  • Long-term Monitoring: Regular follow-up to monitor lung function, skin health, and overall health status.

7. Prevention

Preventing diseases caused by ammonia involves implementing strict control measures in the workplace:

  • Engineering Controls: Using local exhaust ventilation, enclosed processes, and proper maintenance of equipment to reduce airborne exposure to ammonia vapors.
  • Work Practices: Implementing safe work practices such as proper handling and disposal of ammonia-containing materials, and avoiding eating, drinking, or smoking in areas where ammonia is used.
  • Personal Protective Equipment (PPE): Providing and ensuring the use of appropriate respirators, protective clothing, gloves, and eye protection.
  • Health Surveillance: Regular health screenings, including pulmonary function tests and skin examinations, for workers exposed to ammonia.
  • Education and Training: Informing workers about the hazards of ammonia and safe work practices to minimize exposure.

Workplace Exposure Limits:

  1. OSHA PEL (Permissible Exposure Limit):

    • Time-Weighted Average (TWA): 50 ppm (parts per million) during an 8-hour workshift.
    • Short-Term Exposure Limit (STEL): 35 ppm.
  2. NIOSH REL (Recommended Exposure Limit):