Massive Anhydrous Ammonia Injury Leading to Lung Transplantation

Abstract

Chemical burns are responsible for only a small proportion of admissions to a burn center (3.1– 16%).1 These may occur with household chemical products because of their extensive availability but usually as a result of industrial accidents. It has been estimated that there are 25, 000 chemical agents capable of causing chemical injuries.2 Among these, anhydrous ammonia is responsible for about one-third of all reported chemical burns (32– 34%).3, 4 At room temperature, anhydrous ammonia is a colorless, highly irritating gas with a pungent and suffocating odor, while compressed under high pressure, it forms a clear and colorless liquid. It is a hygroscopic substance, meaning that it readily takes up and retains water from its surroundings, including the human body. Therefore, it has a predilection for moisture-rich areas such as the skin, eyes, and mucous membranes of the gastrointestinal and respiratory tract.3 Lung damage due to inhalation is often the most dangerous injury, with clinical impairment of respiratory function ranging from mild to fatal.5 Additionally, evaporation of pressurized liquid anhydrous ammonia can result in a frostbite injury.6, 7 We present a case of a male adult patient involved in industrial accident with pressurized anhydrous ammonia resulting in large skin burn, injuries to both the eyes, and life-threatening lung injury leading to lung transplantation. To our knowledge, this case report is the first describing successful lung transplantation after a massive anhydrous ammonia inhalation injury.