Ammonia is the third most abundantly produced toxic chemical in the world. Anhydrous ammonia is a pungent and toxic gas used extensively as a fertilizer in agriculture. In 12 million tons of ammonia were used as fertilizer. Anhydrous ammonia is stored and transported as a liquid in pressurized tanks. If it is released from the pressurized container, anhydrous ammonia will immediately return to a gaseous state and can cause respiratory toxicity.
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The CDC reports ammonia to be the most common chemical involved in single agent toxic exposures. On April 17, , a fire and an ammonium nitrate explosion at the West Fertilizer Company in West, Texas, resulted in 15 fatalities and injuries. Part of such preparedness is conveying information to clinicians, which is the objective of this case report.
An year-old male farmer was accidently exposed to anhydrous ammonia released from an ammonia fertilizer tank. The patient was driving a tractor and fertilizing the fields with ammonia Figure.
Keywords: ammonia, toxic inhalation, acute respiratory failure, agriculture. Civic chiefs believe there is space for more homes at Winnall Flats. He was moved to a local hospital emergency department after an estimated minutes of exposure to anhydrous ammonia. In about 12 million tons of ammonia were used in the production of fertilizers. Jonathan Kauffman is a San Francisco Chronicle staff writer.
A pipeline from the ammonia tank was broken, and gas filled the cab of the tractor. He was not wearing any protective gear. He was moved to a local hospital emergency department after an estimated minutes of exposure to anhydrous ammonia. On arrival, he was confused with a pulse rate beats per minute, temperature His tongue was edematous, and his lips, nasal mucosa, and oral mucosa were erythematous.
He was in acute respiratory distress and auscultation of the lungs demonstrated expiratory wheezing. Endotracheal intubation was performed. His initial management included mechanical ventilation, intravenous fluids, and pulmonary care. He was treated with corticosteroids and empiric antibiotics. He had intermittent fever, leukocytosis, and copious tracheal secretions. His respiratory status deteriorated progressively despite protective lung ventilation measures. Due to unremitting hypoxemia and refractory alveolar edema, the patient underwent bronchoscopy.
Initial bronchoscopic examination revealed diffuse erythematous tracheobronchial mucosa, petechiae, extensive bronchial mucosal sloughing, and obstruction of the subsegmental bronchi. The sloughed mucosa was removed from obstructed bronchi using a therapeutic bronchoscope with a cryoprobe. Post procedure, his oxygenation improved, and his positive end expiratory pressure was reduced.
On day twelve of admission, he was extubated. Shortly after extubation, he developed respiratory distress and required subsequent re-intubation. Tracheostomy was recommended, but his family decided on comfort measures. Subsequently, he was terminally extubated.
Under atmospheric pressure, anhydrous ammonia is a colorless gas. For use as an agricultural fertilizer, it is compressed into a liquid state.
Exposure to anhydrous ammonia can cause injury by two distinct mechanisms. Second, vaporization of ammonia is toxic to skin, eyes, and respiratory mucosa by the formation of hydroxyl ions OH which cause chemical burns by liquefactive necrosis. Inhalation is the most frequent mode of exposure to anhydrous ammonia. The acute effects from inhalation range from mild to severe clinical presentations.
Mild symptoms include nasal and throat irritation causing cough. Moderate injury causes edema and erythema of the lips and respiratory mucosal surfaces.
Clinical findings in cases with moderate exposures include pharyngitis, laryngitis, productive cough, and bronchospasm. Patients may have rapid, shallow breathing, rhonchi, and blood tinged sputum. Severe effects include second and third-degree burns to the mucosa of the nasal passages, soft palate, larynx, and respiratory mucosa.
Airway obstruction, severe bronchospasm, and copious sputum production can occur. Both epithelial and endothelial damage develop in alveolar injury resulting in an alveolar capillary leak and the pathologic changes of adult respiratory distress syndrome ARDS. Severe damage to alveoli from inhalation injury is referred to as diffuse alveolar damage DAD. She was only three months old.
When the couple was in Denver, they were tested for the genetic mutation and found out that they were both carriers. After much research the couple learned that they could greatly reduce those chances through in-vitro fertilization. During the process, eggs would be gathered from the potential mother and tested for the genetic mutation.
Only eggs free from the mutation would be combined with the sperm from the father, reducing the chance of the disease occurring in the child to almost nil. Kirstyn works as a certified nurses assistant and is very open to using her skills to raise a child who might have special medical needs. So, we might end up adopting a child with those kinds of needs.
The couple is not ready to give up on their dream to raise a family, she said. Skip to content. When the baby was two months old, numerous tests revealed the rare condition. By Patti Carpenter. Share this story Facebook Twitter Email Print. Sorry, your blog cannot share posts by email.