Household cleaners involved:
(1) ammonia-based, with 3-10% ammonia
(2) bleach, typically 5.25% sodium hypochlorite
Mixing results in formation of chloramine gas, composed of mono- and di-chloramine. The gas breaks down to ammonia and hydrochlorous acid. The latter when mixed with water generates hydrochloric acid and oxygen free radicals. In addition, chlorine gas may released by breakdown of the hypochlorite in bleach.
Consequences of exposure to the gases may range from mild to severe:
(1) eye irritation
(2) nasal or throat irritation
(3) dizziness
(4) nausea
(5) respiratory irritation with cough and choking to dyspnea and wheezing to toxic pneumonitis, which can lead to pulmonary edema and ARDS
Most exposures are mild and transient. Rarely a person may have a serious exposure requiring hospitalization and ventilatory support.
Risk factors for serious exposure:
(1) cleaners with high concentrations of reactive compounds
(2) large amount of cleaners involved
(3) enclosed space with little air exchange
(4) prolonged exposure, typically lasting beyond the onset of initial irritation
(5) underlying cardiopulmonary disease
