Can Chloramine Gas Kill You? Signs, Symptoms, and Prevention

Chloramine gas can kill, but reported deaths are very rare, and most people who breathe it while cleaning recover fully once they reach fresh air.1PubMed. Unexpected death due to chloramine toxicity in a woman with a brain tumor It is still a real poison that can inflame the lungs badly enough to need hospital care, so it isn’t a smell to tough out. The danger is almost always self-made at home, from mixing bleach with another cleaner, which also makes it one of the easiest poisonings to prevent.2Washington State Department of Health. Dangers of Mixing Bleach with Cleaners

How Bleach and Ammonia Make Chloramine

Household bleach is a solution of sodium hypochlorite, roughly 5 to 10 percent, and household ammonia cleaners are about 5 to 10 percent ammonia in water.3Alliance Chemical. Chloramine Gas: What Happens When You Mix Bleach and Ammonia When the two meet, the bleach hands a chlorine atom to the ammonia and makes monochloramine, the main “chloramine gas.”4Alliance Chemical. Chloramine Gas: What Happens When You Mix Bleach and Ammonia The mix can also form dichloramine, trichloramine and other toxic or even explosive products, but not pure chlorine gas.5Wikipedia. Chlorine bomb Some of the chloramine escapes the liquid as a sharp, choking vapor, and the leftover puddle is caustic, so don’t touch it bare-handed.6Alliance Chemical. Chloramine Gas: What Happens When You Mix Bleach and Ammonia

The reaction starts the moment the liquids touch, so gas can rise within seconds of a splash or pour, before you have time to notice what you did. A bathroom is the worst place for it: it is small, often has the door shut, and has little airflow, so gas stays at breathing height instead of drifting away.

The second ingredient is easy to miss. Urine contains ammonia-related compounds, so bleach poured onto a urine-soaked toilet, litter box or diaper bucket can make chloramine with no ammonia bottle in sight. Some glass cleaners and multi-surface sprays contain ammonia, and the front label may not say so, so the ingredient list is what to check. Using two products back to back on one surface can mix them there, even if you never combined them in a bucket.

Chloramine breaks down into reactive particles that damage the moist lining of the airways.7PubMed Central. Trends in chlorine and chloramine gas exposures reported to United States poison centers The injury can set off ongoing inflammation that harms the lungs’ air sacs and the coating that keeps them open.8PubMed Central. Mechanisms and Modification of Chlorine-induced Lung Injury in Animals At similar concentrations chloramine is less severe than chlorine gas, though still harmful.9PubMed Central. Trends in chlorine and chloramine gas exposures reported to United States poison centers

Signs and Symptoms of Chloramine Exposure

Symptoms range from minor irritation of the nose and throat to severe lung injury.10PubMed. Unexpected death due to chloramine toxicity in a woman with a brain tumor The eyes can turn red and sore, and the nose, mouth and throat can feel burned.11PubMed. Choking agents and chlorine gas – History, pathophysiology, clinical effects and treatment Coughing and eye irritation are the most common complaints, and some people get a rash.12PubMed. Health effects associated with indoor swimming pools: a suspected toxic chloramine exposure

A typical household exposure goes like this: you notice a sharp smell, your eyes water, and you start coughing within minutes of the mixing. Your throat and chest may feel raw or tight for a while after you leave the room, which is expected and not by itself a sign of serious injury. Symptoms that ease steadily once you are in fresh air are a good sign, though they don’t rule out problems that show up later.

These symptoms signal danger:

That last one is the symptom people miss. Fluid can build slowly, so you can feel nearly normal and then get worse hours later. New breathlessness, or a cough that grows worse later the same day, needs prompt medical attention even if you felt fine when you left the room.

When Chloramine Becomes Deadly

Fatal chloramine poisoning is so rare that one reported death of a woman cleaning her bathroom was described as the first of its kind.17PubMed. Unexpected death due to chloramine toxicity in a woman with a brain tumor She had an undiagnosed brain tumor, which shows how other health problems can tip a usually survivable exposure into a fatal one.18PubMed. Unexpected death due to chloramine toxicity in a woman with a brain tumor

Several things raise your personal risk. People with asthma or other lung disease have airways that react more strongly, so a small exposure can bring on a worse attack. A small, closed room lets fumes concentrate, which makes the dose much higher than the same spill in a large, ventilated space. Staying in the room to finish cleaning lengthens exposure, and that is easy to avoid by leaving at the first sting. Children and older adults have less breathing reserve, so a drop in oxygen can become dangerous faster.

Serious injury is more common than death. Chloramine can cause chemical pneumonitis, an inflammation of the lungs caused by a chemical rather than an infection.19CHEST. Chemical Pneumonitis From Chloramine Gas Exposure: A Case Report In one reported case, a 9-year-old boy who urinated into a bucket of bleach developed lung inflammation and his blood oxygen fell to 78%, far below the normal mid-90s.20PubMed Central. Chloramine/Chlorine Injury Treated with Noninvasive Positive Pressure Ventilation: A Report of Two Cases With breathing support from a mask that pushes air in, he improved and went home on day four.21PubMed Central. Chloramine/Chlorine Injury Treated with Noninvasive Positive Pressure Ventilation: A Report of Two Cases With prompt recognition and treatment, most people with lung injury recover well.22CHEST. Chemical Pneumonitis From Chloramine Gas Exposure: A Case Report

What to Do Right After Breathing the Fumes

  • Leave the room and get into fresh air right away.
  • If you can do so without breathing more fumes, open windows and turn on a fan, then stay out.
  • Rinse eyes with lukewarm water for 15 minutes and wash skin touched by the caustic liquid.
  • Call Poison Control at 1-800-222-1222 in the US for free advice on whether you need care.
  • Call 911 for trouble breathing, throat tightness, chest pain or confusion.

When you call Poison Control or a doctor, name the products you mixed and read the labels if you have them. Say how long you were in the room, whether it was ventilated, and what symptoms you have and when they started.

A few common mistakes make things worse. Adding another cleaner to neutralize the mix can release more gas, so leave the spill alone until the air has cleared. Going back in to finish the job restarts the exposure and can turn a mild episode into a serious one. Waiting out severe breathlessness at home delays care that can be needed urgently, so call 911 rather than hoping it passes.

Once the room has aired out thoroughly, with windows open and a fan running, you can deal with the puddle. Keep children and pets out. Wear rubber gloves because the leftover liquid is caustic and can burn bare skin, dilute the puddle with plenty of water, and rinse it down the drain instead of mopping it up in a concentrated form.

In the hospital, treatment mainly supports breathing with oxygen, airway-opening medicines and, if needed, a breathing mask.23PubMed Central. Chloramine/Chlorine Injury Treated with Noninvasive Positive Pressure Ventilation: A Report of Two Cases There is no antidote, and inhaling a baking soda mist made no difference in a group of 22 exposed patients.24Europe PMC / Military Medicine. Mass casualties from acute inhalation of chloramine gas.

Can Chloramine Cause Lasting Lung Damage

Most people whose symptoms were mild and faded in fresh air have no lasting problems. A cough or breathlessness that lasts more than a few days is worth a medical check-up, because it can mean the airways are still inflamed. People with asthma may have flare-ups for a while afterward, so they should keep their usual treatment close and follow their action plan.

Repeated exposure is the main long-term concern. Chloramines also form in pool water when chlorine reacts with sweat and urine, and trichloramine easily escapes into the air above it.25PubMed. Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting In one indoor-pool outbreak with high chloramine levels, swimmers and people near the pool developed cough, eye irritation and rash.26PubMed. Health effects associated with indoor swimming pools: a suspected toxic chloramine exposure In pool workers, eye and airway irritation starts at roughly 0.4 mg of trichloramine per cubic meter of air.27Taylor & Francis Online / PubMed Central. Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting Prolonged chloramine exposure has been linked to asthma, bronchitis and lung scarring.28Chloramine Consulting. Chloramine Poisoning: Symptoms, Exposure Limits and Treatment

Drinking water is a different matter. Many cities add small amounts of monochloramine to tap water, and at tap-water levels it caused no health effects in volunteers.29PubMed. Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

How to Prevent Chloramine Exposure at Home

Accidental mixing tends to happen in a few familiar spots. Pouring bleach into a toilet that still holds another bowl cleaner can mix the two in a small, enclosed space. Mopping with bleach after an ammonia floor cleaner mixes the products on the floor, so rinse the floor with water first. Wash urine-soaked areas with water and ventilate before using bleach.

For tough jobs, use one product at a time, exactly as the label directs, instead of combining products for extra strength. For mold or disinfecting, bleach diluted in water works on its own and needs no additive. If you use bleach often, choose ammonia-free glass and surface cleaners so an accidental overlap is less likely. Children should be taught that nothing gets added to bleach, including things that seem harmless, and bleach should be stored out of their reach.

Fumes can linger even when nothing was mixed. Ordinary bleach cleaning releases chlorine gases that react with other chemicals in indoor air and on surfaces.33PubMed. Surface Reactions of Organic Amines during Indoor Bleach Cleaning: Nitrosamine, Hydrazine, Chlorinated, and Dimer Product Formation These reactions can leave new chlorinated products stuck on surfaces like glass and paint.34PubMed Central. Gas-Phase and Surface-Initiated Reactions of Household Bleach and Terpene-Containing Cleaning Products Yield Chlorination and Oxidation Products Adsorbed onto Indoor Relevant Surfaces Airing out the room during and after bleach cleaning lowers what you breathe.