Ammonia

A patient seen with ammonia exposure showed severe deficiencies of the nervous system after a brief inhalation. He was working near a chemical plant, heard an explosion and saw a cloud emanating from that plant, and ran away but was quickly enveloped by the cloud. He felt that he had been hit in the chest, had ringing in his ears, almost daily frequency of 35 symptoms, scoring 10.3 on the 11 points scale. His choice reaction times approached two seconds (2,000 milliseconds), four times the normal half second (500 milliseconds). Balance abnormal, abnormal blink reflex, greatly diminished strength of grip, extremely constricted visual fields and extreme loss of hearing. Problem solving and memory functions were almost absent, for example he took 351 seconds to put 25 pegs in a grooved pegboard 5 times the normal of 70 seconds and needed 267 seconds, 10 times normal to connect the 25 numbered circles of Trails A. He also had extremely poor recall and remote memory. A nonfatal, one-time dose of ammonia produced profound impairment of the central nervous system.