Chemical burns are associated with significant morbidity, especially anhydrous
ammonia burns. Anhydrous
ammonia is a colorless, pungent gas that is stored and transported under pressure in liquid form. A 28 year-old patient suffered 45% total body surface area of second and third degree
burns as well as inhalational injury from an anhydrous
ammonia explosion. Along with fluid
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 subsequently underwent a total of seven
wound debridements; initially with allograft and then autograft. On post
burn day 45, he was discharged. The
injuries associated with anhydrous
ammonia burns are specific to the effects of
ammonium hydroxide. Severity of symptoms and tissue damage produced is directly related to the concentration of
hydroxyl ions. Liquefactive
necrosis results 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
iritis,
glaucoma,
cataracts, and
retinal atrophy. The desirability of treating anhydrous
ammonia burns immediately cannot be overemphasized. Clothing must be removed quickly, and irrigation with water initiated at the scene and continued for the first 24 h. Resuscitative measures should be started as well as early
debridement of nonviable skin. Patients with significant facial or pharyngeal
burns should be intubated, and the eyes irrigated until a conjunctivae sac pH below 8.5 is achieved. Although health care professionals need to be prepared to treat
chemical burns, educating the public, especially those workers in the agricultural and industrial setting, should be the first line of prevention.