Anhydrous ammonia, a pungent, colorless gas or liquid, is commonly used around the world as a refrigerant and fertilizer in agriculture. It is an alkali causing liquefaction or freeze-dry lesions with skin contact. Initial emergency response involves evacuation, decontamination, first aid and alerting proper authorities. Decontamination must be complete and rescuers must avoid being overcome by fumes. Emergency department care is directed at respiratory, ocular, skin and gastrointestinal treatment. Respiratory and ocular lesions tend to be the most severe and can be used as a triage guide. The need for a multidisciplinary approach to hospital care is stressed. In severe exposures, adult respiratory distress syndrome is a common finding. In children who have ingested aqua ammonia, early endoscopy, aggressive antibiotic therapy and serial dilatations of strictures are recommended. Long-term complications occur predominately to the eyes and respiratory tract.