Chloramine-induced pneumonitis from mixing household cleaning agents.

Gapany-Gapanavicius, M; Molho, M; Tirosh, M

doi:10.1136/bmj.285.6348.1086

Cited by 26 publications

(3 citation statements)

References 2 publications

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“…Bleach mixed with ammonia (ammonium hydroxide) results in the release of chloramine gas. The release of the gas in a small, poorly-ventilated room produces nausea, respiratory irritation, and in severe cases, pneumonitis (Gapany-Gapanavicius, Malho, & Tirosh, 1982). When bleach is combined with toilet cleaners (sulfuric or hydrochloric acid), chlorine gas and sulfur oxides develop.…”

Section: Bleach and Ammoniamentioning

confidence: 97%

Chemical Hazards in the Household: What Every Community Health Nurse Should Know

Bunge¹

1985

Journal of Community Health Nursing

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Section: Bleach and Ammoniamentioning

confidence: 97%

Chemical Hazards in the Household: What Every Community Health Nurse Should Know

Bunge¹

1985

Journal of Community Health Nursing

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“…Mixing solutions of ammonia and sodium hypochlorite results in acrid chloramine fumes (Gosselin et al 1984). Gapany-Gapanavicius et al (1982) reported the case of a healthy 27year-old woman who mixed ammonia and sodium hypochlorite in a small and poorly ventilated bathroom. The vapors from the mixture caused burning sensations in the eyes and throat, dyspnea, coughing, nausea and vomiting.…”

Section: Accidental Exposurementioning

confidence: 99%

Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Wastensson

Eriksson

2020

Critical Reviews in Toxicology

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Inorganic chloramines are not commercially available, but monochloramine is produced in situ for disinfection or for use in chemical synthesis. Inorganic chloramines are also formed when free chlorine reacts with nitrogen containing substances, e.g. ammonia and urea, present in chlorinated water sources. Occupational exposure may, therefore, occur in e.g. swimming pool facilities and the food processing industry. Monochloramine is soluble and stable in water and the dominating inorganic chloramine in chlorinated water sources. No clinical effects were seen in healthy volunteers given monochloramine in drinking water during 4 or 12 weeks in doses of 0.043 or 0.034 mg/kg bw/day, respectively. Limited data indicate that monochloramine is weakly mutagenic in vitro but not genotoxic in vivo. One drinking water study indicated equivocal evidence of carcinogenicity in female rats but not in male rats and mice. No reproductive or developmental effects were shown in rodents in the few studies located. Dichloramine is soluble but unstable in water. In the only study located, mild histological effects in kidneys, thyroid and gastric cardia were observed in rats administered dichloramine in drinking water for 13 weeks. Trichloramine is immiscible with water and evaporates easily from water into air. Therefore, the primary exposure route of concern in the occupational setting is inhalation. Occupational exposure to trichloramine has been demonstrated in indoor swimming pool facilities and in the food processing industry where chlorinated water is used for disinfection. Exposure-response relationships between airborne levels and self-reported ocular and upper airway irritation have been shown in several studies. Exposure to trichloramine may aggravate asthma symptoms in individuals with existing asthma. The risk of developing asthma following long-term exposure to trichloramine cannot be evaluated at present. No data on genotoxic, carcinogenic, reproductive or developmental effects were located. The toxicological data for mono-and dichloramine are insufficient to recommend health-based occupational exposure limits (OELs). As regard trichloramine, the critical effect is judged to be irritation observed in several studies on pool workers, starting at approximately 0.4 mg/m 3 (stationary sampling). Based on these data, a health-based OEL of 0.1 mg/m 3 (8-h time-weighted average) is recommended. This corresponds to 0.2 mg/m 3 for stationary measurements in swimming pool facilities. No short-term exposure limit (STEL) is recommended.

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“…Several cases have been documented when solutions of ammonia and sodium hypochlorite were mixed and chloramines were formed which, when inhaled, resulted in acute toxic pneumonitis. 16,17 10. NIOSH recommends that the use of tobacco products be curtailed in situations where employees may be exposed to chemical substances which may interact with tobacco products and where non-smoking workers may be exposed to side-stream cigarette smoke.…”

mentioning

confidence: 99%

Health hazard evaluation report: HETA-93-0230-2405, Tyson Foods, Monett, Missouri.

1994

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Chloramine-induced pneumonitis from mixing household cleaning agents.

Cited by 26 publications

References 2 publications

Chemical Hazards in the Household: What Every Community Health Nurse Should Know

Chemical Hazards in the Household: What Every Community Health Nurse Should Know

Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Health hazard evaluation report: HETA-93-0230-2405, Tyson Foods, Monett, Missouri.

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