PHILIPPINE GENERAL HOSPITAL

University of the Philippines Manila

National Poison Management and Control Center
Taft Avenue, Manila
PHIC-Accredited Health Care Provider
ISO 9001:2008 Certified

AMMONIA ALGORITHM 2021

TRIAGING:

Signs and Symptoms Management

GREEN Asymptomatic patients with a reliable Observe for 24 hours

historian

Patients with minor sensations of:

burning of the nose, throat, eyes or
respiratory tract. Slight cough or
rhinorrhea

DELAYED - If the medical personnel feels that Observed for at least 24

the patient has been exposed to a hours or as long as the
significant amount of ammonia Medical Officer deems
despite a relatively benign clinical necessary
appearance.

- Young kids (especially infants or

patients with special needs)

YELLOW Persistent cough, burning or tearing Admit for at least 24 hours.

of the eyes, dizziness, headache, Discharge only if 24 hours
nausea and vomiting asymptomatic.

RED Drowsiness, changes in sensorium, Admit

chest pain, difficulty of breathing,
wheezing, cyanosis, respiratory
depression

BLACK Deceased
ALGORITHM OF MANAGEMENT OF ACUTE TOXICITY

History Amount and Concentration of Ingestion/exposure

Time of Exposure

Route of Exposure

Source of Exposure

Field treatment done, if any

Concurrent exposure to other gases or chemicals

Symptoms of acute ammonia poisoning (See acute effects above)

Physical Complete physical and neurologic examination

Examination Look for signs of caustic injury and respiratory distress

Laboratory Toxicologic Examination:

Examinations

General Examinations:

CBC ABG Electrolytes Urinalysis

Liver function Test Renal function test Blood typing

Chest x-ray PA upright, abdominal xray RBS

*Healthcare workers should wear proper PPE.

General Measures: ABCs of life support

Maintain vital signs

Intubate if with progression of respiratory depression

Put patient on NPO. Give intravenous fluids.

Adult: D5 0.9NaCl or AR 1 liter x 8 hours

Child: D5 0.3NaCl or AR according to KBW

If poison is absorbed through skin, inhaled, ingested then vomited:

 - If clothes has have been exposed to contamination, then
care must be taken when undressing. Cut clothes instead
of being pulled over the head.

- Wash exposed skin with soap and water. Cover all open
wounds prior to washing. Flush exposed skin and hair with
plain water for 2 – 3 minutes then wash twice with mild
soap. Rinse thoroughly with water.

- Remove all clothing and place in a labelled durable 6mil

polyethylene bag

If eyes are exposed or irritated, irrigate with copious amount of

plain water or saline for at least 15 minutes. Remove contact
lenses carefully.

Treatment of Specific Problems

For Asymptomatic patients: Observe for at least 6 hours.

Upper Airway Edema: Glottic edema: Cricothyroidectomy or tracheostomy

Dexamethasone 1mg/kg/day or

Methylprednisolone 2 mg/kg/day

Eye Injury: All patients with corrosive eye injury should be evaluated by
an Ophthalmologist. Patients who have eye injuries should be reexamined by an
ophthalmologist in 24 hours.

Supportive management:

Bronchodilators by nebulizers or metered dose aerosol for bronchospasm

and dyspnea. Consider racemic epinephrine aerosol for children who develops
stridor. Dose 0.25 – 0.75 ml of 2.25% racemic epinephrine solution in 2.5 ml water.
Repeat every 20 minutes as needed cautioning for myocardial variability.

IV methylprednisolone in doses up to 30mg/kg initially with subsequent

smaller doses or by the use of steroids in metered-dose aerosol form at several
times the normal maintenance dosage.

Prophylactic antibiotic except for mild cases since bacterial infection can
occur.
 For pulmonary edema, intermittent positive-pressure ventilation combined
with bronchial toilet and suction are the important elements of treatment.

Severe and extensive burns will require fluid replacement and correction of
metabolic acidosis and will benefit from treatment in a specialist burns unit

Ensure thermoregulation especially for elderly and pediatric patients.

Disposition

All GREEN patient should be observed for at least 24 hours.

If the medical personnel feels that the patient has been exposed to a significant amount
of ammonia despite a relatively benign clinical appearance, young kids (especially infants
or patients with special needs) → observe for up to 24 hours before discharge. If in doubt,
may observe longer. (GREEN - DELAYED)

All YELLOW patients should be admitted for at least 24 hours. Discharge only if 24 hours
asymptomatic.

If patient is for discharged, make sure that the area is already cleared by their LGU and
already safe to go back home.

If Area is NOT yet clear, advise to go first to other shelter

All patients with symptoms after discharged, should go back to the hospital immediately
if any of the following occurs:

Burning of the eyes Burns on the skin

Tearing/redness of the eyes Dizziness

Blurring of vision / Headache

Visual Disturbances Fatigue

DOB/Hyperventilation Chest Pain

Coughing Nausea/Vomiting

Wheezing Changes in Sensorium /

drowsiness
Cyanosis

Patients can have delayed symptoms within 48 hours post exposure.

 PHILIPPINE GENERAL HOSPITAL
University of the Philippines Manila
National Poison Management and Control Center
Taft Avenue, Manila
PHIC-Accredited Health Care Provider
ISO 9001:2008 Certified

DISPOSITION CHECKLIST/TAGUBILIN PAG – UWI:

Magbantay para sa mga sumusunod na sintomas sa susunod na 48 oras.

Burning of the eyes/ pananakit ng mata

Tearing/redness of the eyes/ pagluluha o pamumula ng mata

Blurring of vision / Visual Disturbances/ panlalabo ng paningin

DOB/Hyperventilation/ hirap sa paghinga

Coughing/ Ubo

Wheezing/ Paghingal

Cyanosis/ pangingitim ng labi

Burns on the skin/ Paso

Dizziness/ Hilo

Headache/ Pananakit ng ulo

Fatigue/ Pagod o Hapo

Chest Pain/ Pananakit ng dibdib

Nausea/Vomiting/ pagsusuka o nasusuka

Changes in Sensorium / drowsiness/ Inaantok o nawalan ng malay

Ang paninigarilyo ay pwedeng magpalala sa problem sa baga. Iwasan muna ito sa

susunod na 3 araw.

Maaring tumawag sa National Poison Management and Control Center hotline:

02-85241078, 02-8554800 local 2311 o sa 09667189904 sa anumang katanungan.