Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners

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Abstract
The inhalation of the noxious fumes associated with the mixing of household cleaners can lead to pulmonary irritation and pneumonitis. Household ammonia (3 to 10 percent aqueous NH3) and bleach (5 percent NaOCl) are two of the most common cleaning agents. Combining them releases chloramine gas, which is a combination of monochloramines (NH2Cl) and dichloramines (NHCl2). When inhaled, chloramines react with the moisture of the respiratory tract to release ammonia (NH3), hydrochloric acid (HCl), and oxygen free radicals. Typically, exposures to low concentrations of chloramines produce only mild respiratory tract irritation. In higher concentrations, the combination of hydrochloric acid, ammonia, and oxygen free radicals may cause corrosive effects and cellular injury, resulting in pneumonitis and edema.1-4