- Derivative of ammonia with substitution of 1-3 hydrogen ions by chlorine.
- Monocholramine NH2Cl
- Dichloramine NHCl2
- Nitrogen trichloride NCl3
- Inhalation causes chloramines to react with moist mucus membranes releasing ammonia, hydrogen chloride, and oxygen free radicals
- Produced with the mixing of household cleaning agents containing ammonia and bleach
- Most common form of exposure
- Thousands of exposures annually but few people seek medical attention as most exposures are mild.
- Inhalation exposure
- Upper airway irritation
- Rarely; Stridor and upper airway edema
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
- History of using home cleaning agents in an enclosed space
Symptoms may be worse in patient's with asthma or COPD
- Most patients will not require any treatment
- Consider X-ray
- Oxygen as need for low O2 saturation
- 2.5-5mg nebulized Q20 minutes or continuous nebulizer
- Intravenous steroids
- Epinephrine nebulized
- Consider for patient's with stridor, voice changes, or continuous dyspnea despite aforementioned treatment
- If the exposure is severe and the patient is unstable or continues to decline despite management above then consider intubation
- Most patients can be observed for 4-6 hours in the ED
- If asymptomatic after observation the patient can be discharged home
- Consider repeat X-ray
- Consider admission or in house observation for asthmatics/COPD patients or those with continued symptoms after 4-6 hours
- ↑ Tanen, David A., Kimberlie A. Graeme, and Robert Raschke. "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners." New England Journal of Medicine N Engl J Med 341.11 (1999): 848-49. New England Journal of Medicine. Web. 16 Oct. 2015.
- ↑ US National Library of Medicine. TOXNET: Toxicology Data Network.