• Derivative of ammonia with substitution of 1-3 hydrogen ions by chlorine.
    • Monocholramine NH2Cl
    • Dichloramine NHCl2
    • Nitrogen trichloride NCl3
  • Inhalation causes chloramines to react with moist mucus membranes releasing ammonia, hydrogen chloride, and oxygen free radicals[1]
  • Produced with the mixing of household cleaning agents containing ammonia and bleach
    • Most common form of exposure
  • Thousands of exposures annually but few people seek medical attention as most exposures are mild.

Clinical Features

Inhalation exposure
  • Dyspnea
  • Upper airway irritation
  • Cough
  • Wheezing
  • Rarely; Stridor and upper airway edema

Differential Diagnosis

Acute dyspnea




  • History of using home cleaning agents in an enclosed space


Symptoms may be worse in patient's with asthma or COPD

  • Most patients will not require any treatment
  • Consider X-ray
  • Oxygen as need for low O2 saturation
  • Albuterol
    • 2.5-5mg nebulized Q20 minutes or continuous nebulizer
  • Intravenous steroids
  • Epinephrine nebulized
    • Consider for patient's with stridor, voice changes, or continuous dyspnea despite aforementioned treatment
  • If the exposure is severe and the patient is unstable or continues to decline despite management above then consider intubation
    • Consider awake fiberoptic intubation given upper airway swelling/edema
    • Prepare for cricothyrotomy simultaneously if intubation fails


  • Most patients can be observed for 4-6 hours in the ED[2]
  • If asymptomatic after observation the patient can be discharged home
  • Consider repeat X-ray
  • Consider admission or in house observation for asthmatics/COPD patients or those with continued symptoms after 4-6 hours

See Also


  1. Tanen, David A., Kimberlie A. Graeme, and Robert Raschke. "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners." New England Journal of Medicine N Engl J Med 341.11 (1999): 848-49. New England Journal of Medicine. Web. 16 Oct. 2015.
  2. US National Library of Medicine. TOXNET: Toxicology Data Network.
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