Anhydrous Ammonia Burns

Anhydrous ammonia, a caustic compound commonly used in industry, can cause severe burns, even with brief contact. As with other alkali burns, early irrigation to remove the ammonia from burned areas is crucial to limit tissue damage. Two cases of identical exposure to industrial strength ammonia are presented. Each patient was exposed to ammonia liquid and vapors simultaneously when a tank containing this compound exploded. One patient showered at the scene immediately after exposure, whereas the other deferred irrigation until he arrived at the hospital. The first patient suffered minor burns with a 2-day, uncomplicated hospital stay. The second patient suffered 14% total body surface area burns and a significant inhalation injury. He required intubation, mechanical ventilation, and skin grafting during his 13-day hospitalization. Although much is written about the management of chemical burns, few articles address ammonia burns. Aggressive initial management significantly reduces morbidity of ammonia burns.