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Smelling salts

Smelling salts are chemical preparations, typically consisting of ammonium carbonate mixed with perfume or diluted ammonia in water and ethanol, that release pungent ammonia vapors when sniffed to stimulate consciousness and revive individuals from fainting or syncope.^[1]^[2] These inhalants, also known as ammonia inhalants or aromatic spirits of ammonia, have been used since ancient times, with references dating back to the Roman era as "Hammoniacus sal" described by Pliny, evolving through medieval alchemical uses as "sal ammoniac" and 17th-century production from distilled hartshorn (deer antler shavings) into perfumed forms popularized in the Victorian period for treating swooning, particularly among women in corseted attire.^[1]^[3] Historically employed as a folk remedy for fainting by irritating the nasal membranes and triggering a reflexive inhalation that boosts oxygen to the brain and activates the sympathetic nervous system for an alertness surge, smelling salts fell out of routine medical favor by the 20th century in favor of simpler interventions like elevation of the legs.^[4]^[5] In modern contexts, they are considered unapproved new drugs by the FDA, which has issued warnings against their use for alertness, and are primarily used by athletes in high-impact sports such as football, hockey, and powerlifting—where many NFL players have employed them—to heighten arousal before performance or after impacts, though as of August 2025 the NFL has banned teams from providing them due to safety concerns; evidence for ergogenic benefits is limited to minor improvements in repeated high-intensity efforts like the Wingate test, with no enhancement in single maximal sprints.^[6]^[5]^[7]^[8] Contemporary formulations often contain about 15% ammonia alongside essential oils like lavender or lemon for scent, delivered in crushable ampoules or packets.^[6] Despite their stimulant effects, smelling salts carry risks including respiratory irritation, coughing, allergic reactions such as rhinitis, potential chemical burns to nasal passages or skin from overuse, and the critical danger of masking concussion symptoms by inducing a withdrawal reflex that delays diagnosis of head injuries.^[6]^[5] They are not addictive but are not recommended for general use due to these hazards and lack of proven long-term safety or efficacy beyond transient arousal.^[5]

Composition and Preparation

Chemical Composition

Traditional smelling salts are primarily composed of ammonium carbonate, a white crystalline solid with the chemical formula (NH_4)_2CO_3, which serves as the active ingredient. This compound decomposes upon exposure to air or moisture, releasing ammonia gas (NH_3), carbon dioxide (CO_2), and water, as represented by the equation:

(NH_4)_2CO_3 \rightarrow 2NH_3 + CO_2 + H_2O

^[1]^[9] In historical formulations, ammonium carbonate was often mixed with perfumes or essential oils to mask the pungent ammonia odor, and it was commonly referred to as "spirit of hartshorn," an early name derived from its production via distillation of animal horns.^[1]^[10] Modern variants of smelling salts typically consist of aqueous ammonia solutions, containing 15-20% ammonia (NH_3) dissolved in water, which provides a more stable and readily deployable form compared to the solid carbonate. These solutions may include added scents such as lavender or eucalyptus oils to reduce the harshness of the ammonia smell.^[10]^[2]^[11] Contemporary formulations often incorporate inactive components like alcohol (ethanol) at concentrations of 35-40% for enhanced stability and solubility, ensuring the product remains effective without rapid degradation.^[11]^[1]

Preparation Methods

Traditional preparation of smelling salts typically involved apothecaries manually mixing ammonium carbonate crystals with water or alcohol, often incorporating perfumes for scent, and allowing the solution to stand or evaporate to form crystallized solids or pearls suitable for crushing and inhalation.^[1] This process relied on the decomposition of ammonium carbonate to release ammonia gas upon exposure to air or moisture.^[12] In modern industrial production, smelling salts are manufactured by dissolving ammonia gas—produced via the Haber-Bosch process—into water or ethanol under controlled temperature and pressure conditions to create solutions of precise concentration, which are then flavored with essential oils such as lavender or lemon.^[13] These solutions are filled into small glass ampoules, sealed, and sometimes surrounded by absorbent material like cotton for safe handling and immediate release upon breakage, or applied to pre-soaked pads for portable use.^[11] Smelling salts are produced in several forms to suit different applications: solid pearls or powders of ammonium carbonate that release ammonia when crushed; liquid inhalants contained in breakable vials; or fabric pads pre-impregnated with ammonia solution for quick activation without tools.^[1] Quality control in production emphasizes maintaining ammonia concentrations within safe limits, such as approximately 15% in ampoule inhalants or 1.7–2.1% total ammonia in aromatic spirits, to ensure effective stimulation while minimizing risks of severe mucosal irritation.^[13]^[14] Manufacturers conduct assays for purity, pH stability, and gas release efficiency to meet pharmaceutical standards.^[11]

History

Origins and Early Use

The origins of smelling salts trace back to ancient practices where various irritant substances were inhaled to restore consciousness and treat ailments like fainting or epilepsy. The ancient Romans knew of ammonium chloride, referred to as "Hammoniacus sal," as described by Pliny the Elder in his Natural History.^[1] These early ammonia-based compounds laid the groundwork for later formulations, though the specific compound ammonium carbonate—derived from the distillation of deer antler shavings, known as hartshorn—was not isolated until the 17th century.^[1] Ammonia solutions, including sal ammoniac, appear in 13th-century European alchemical texts for their reviving properties.^[4] By the 17th century, the distillation process had become more refined, producing "spirit of hartshorn," a volatile alkali used in early pharmacology to counteract unconsciousness and nervous disorders. Early physicians in the alchemical tradition endorsed such ammonia-based inhalants as aromatic waters for rousing the faint, marking a shift toward chemical remedies in medicine.^[1] In the 18th century, smelling salts gained popularity in Europe under the name "sal volatile," an aromatic preparation often scented with lavender or rosemary, primarily to treat fainting spells and "female hysterics" among the upper classes.^[15] These episodes were common in refined society, prompting women to carry vials for immediate revival.^[16] Beyond medical use, sal volatile played a cultural role in theaters and social gatherings, where it combated the "vapors"—a period term for fatigue, anxiety, or nervous exhaustion—allowing participants to endure long performances or tense interactions.^[17]

Evolution in Medicine and Society

In the 19th century, smelling salts gained prominence in medical practice, particularly following the introduction of anesthesia in the mid-1800s, when they were routinely used in hospitals to hasten patients' recovery from unconsciousness by stimulating the respiratory reflex through ammonia inhalation.^[18] Physicians employed them to treat various conditions, including shock, respiratory depression, and fainting during childbirth, integrating them into standard protocols as a quick revival aid.^[18] This era also saw their societal embedding as a staple for Victorian women, who carried ornate vials—often scented with perfumes or vinegar—as "ladies' remedies" to counteract fainting spells attributed to tight corsets, emotional stress, or social expectations of fragility.^[15] By the mid-20th century, smelling salts began to decline in formal medicine as advancements like intravenous drugs and oxygen therapy provided safer, more effective alternatives for managing fainting and unconsciousness, rendering ammonia inhalants obsolete in clinical settings.^[4] Despite this medical fade, their use revived in sports culture during the late 20th century, with athletes in leagues like the NFL and NHL adopting them for heightened alertness.^[6] This shift reflected a broader cultural transition from medical necessity to performance enhancement, though scientific evidence for ergogenic benefits remains limited to specific high-intensity scenarios.^[6] Societally, smelling salts evolved from symbols of Victorian decorum—frequently portrayed in literature and early films as tools to revive swooning heroines—to modern over-the-counter commodities available at supplement stores and online retailers for athletic or everyday arousal boosts.^[5] Media depictions, such as in classic cinema scenes of fainting and revival, perpetuated their nostalgic image while highlighting gender norms of the era.^[15] Regulatory developments underscored this change; ammonia inhalants were classified as non-prescription items by the FDA for fainting treatment, though recent warnings target unapproved variants marketed for energy without proven safety data.^[6] Safety concerns over masking concussion symptoms led to restrictions in some sports, including longstanding bans in professional boxing since the mid-20th century.^[19]

Mechanism of Action

Physiological Effects

When ammonia gas from smelling salts is inhaled, it immediately irritates the nasal mucosa, activating chemoreceptors in the trigeminal and olfactory nerves.^[20] This irritation triggers a reflexive gasp or inhalation response, which sharply increases oxygen intake and heightens alertness by stimulating the medulla oblongata.^[2] The sensory response is rapid, occurring within seconds of exposure.^[21] The activation of the sympathetic nervous system leads to cardiovascular changes, including a brief elevation in heart rate, known as tachycardia.^[20] Earlier studies reported a temporary increase in blood pressure due to reflex vasoconstriction in peripheral vessels, but more recent research indicates no significant change.^[22]^[6] These effects enhance overall arousal but are short-lived. Respiratory stimulation occurs as the irritation prompts an increased breathing rate to expel the irritant, which in turn improves cerebral blood flow through vasodilation of cerebral arteries.^[20] This enhanced oxygenation supports heightened mental acuity during the response. The physiological effects of smelling salts typically peak within seconds to a minute of inhalation and last 1 to 5 minutes, after which the body returns to baseline.^[2]^[21]

Biochemical Processes

The ammonia gas released from smelling salts interacts with the moisture in the nasal mucosa, undergoing a reaction that produces ammonium ions and hydroxide ions, thereby creating a basic environment that irritates the chemoreceptors in the nasal cavity.

\ce{NH3 + H2O -> NH4+ + OH-}

This chemical irritation primarily stimulates polymodal nociceptive neurons associated with the trigeminal nerve (cranial nerve V), which detect irritants and relay sensory signals from the nasal passages to the spinal trigeminal nucleus in the brainstem. ^[23] ^[6] The activated trigeminal afferents trigger a reflex arc pathway, where signals project to the respiratory and vasomotor centers in the medulla oblongata, eliciting an inhalation reflex that enhances respiratory drive. ^[6] The brainstem integration subsequently activates the sympathetic nervous system, prompting the adrenal glands to release adrenaline (epinephrine) into the bloodstream as part of the fight-or-flight response. ^[19] ^[5] Parallel to adrenaline release, the sympathetic activation elevates norepinephrine levels in the peripheral nervous system, promoting heightened arousal and vigilance by enhancing neural signaling at adrenergic receptors without requiring direct penetration of ammonia into the central nervous system. ^[19] ^[24] This neurotransmitter surge amplifies the overall stimulatory effect, focusing the response on peripheral and autonomic pathways rather than central olfactory processing. ^[6]

Uses

Medical Applications

Smelling salts, primarily in the form of ammonia inhalants, have historically been employed in clinical settings to revive patients experiencing syncope, or fainting, particularly vasovagal syncope, by stimulating arousal through irritation of the nasal and pulmonary membranes.^[1] Their use has been noted in emergency rooms and ambulances for rapid restoration of consciousness in cases of transient loss due to hypotension or reflex-mediated events, though modern protocols favor simpler interventions and they are not routinely recommended.^[25] In 2024, the U.S. Food and Drug Administration (FDA) warned against unapproved ammonia inhalant products marketed for alertness or energy, classifying them as unapproved drugs with potential health risks.^[7] Protocols for administration, when used, involve supervised inhalation of the ammonia vapor for 10-15 seconds, with the inhalant held approximately 10-15 cm from the patient's nose to minimize direct mucosal irritation.^[1] In emergency medicine, smelling salts are not recommended as a first-line intervention for cardiac arrest, where cardiopulmonary resuscitation (CPR) and advanced life support take precedence, as they do not address underlying cardiac or respiratory failure.^[26] Some regional EMS guidelines explicitly advise against their routine use for assessing consciousness levels, citing non-diagnostic value.^[26] Their medical role is supported largely by anecdotal evidence dating to the 1800s, with limited randomized controlled trials (RCTs) evaluating efficacy. Historical medical texts, such as 19th-century editions of the Dispensatory of the United States, list ammonia-based smelling salts as an analeptic, or restorative stimulant, for reflex arousal in cases of faintness.^[27] Evidence indicates transient cardiorespiratory stimulation that may aid recovery from vasovagal syncope in some cases, but emphasizes the absence of robust evidence for sustained therapeutic effects. This reflex arousal stems from irritation triggering increased respiratory and heart rates, as detailed in physiological mechanisms.^[1]

Sports and Athletic Use

Smelling salts, also known as ammonia inhalants, are commonly employed in high-impact sports such as American football in the National Football League (NFL), powerlifting, and boxing to counteract fatigue, enhance focus, or revive athletes from a post-knockout daze.^[19]^[28] In the NFL, players have historically used them to achieve a quick mental alertness boost before plays or during huddles, with estimates indicating widespread adoption among 70-80% of athletes as of 2017.^[29] Powerlifters often inhale them immediately prior to maximal lifts, such as deadlifts or bench presses, to trigger an adrenaline response that sharpens concentration and combats perceived exhaustion.^[28] In boxing, they were traditionally administered after knockouts to restore consciousness, though their role has diminished due to regulatory changes.^[19] Athletes typically administer smelling salts by snapping open small ampoules or capsules containing ammonia carbonate and holding them under the nose for a brief, intense inhalation, often during team huddles in football or right before gripping the bar in powerlifting.^[8]^[28] This practice gained prominence in professional sports starting in the late 20th century, with NFL players like Michael Strahan noting their increasing use since the 1990s for clearing mental fog before high-stakes moments.^[29] Similarly, in powerlifting competitions, the ritual has become a staple for psyching up, providing an immediate sensory jolt that athletes describe as invigorating.^[28] Endorsements from prominent figures, such as NFL tight end George Kittle, who expressed strong attachment to the substance amid recent policy shifts, underscore its entrenched role in athletic routines.^[8] Athletes report anecdotal benefits from smelling salts, including heightened focus, increased energy, and a temporary surge in arousal that aids in overcoming fatigue during intense efforts.^[29]^[28] However, scientific evidence reveals no significant ergogenic advantages, particularly in single maximal strength efforts like those in powerlifting or football plays; a 2023 review in Sports Health concluded that benefits are limited to repeated high-intensity bouts, with no enhancement in one-repetition maximum performance such as deadlifts.^[6] Studies, including those examining peak power output, support this, attributing perceived gains to psychological arousal rather than physiological improvements.^[6] The cultural significance of smelling salts extends to professional wrestling, where performers like WWE athletes incorporate them into pre-match rituals for dramatic hype and revival effects.^[30] Controversies have arisen over their safety, leading to restrictions in various leagues; for instance, most boxing organizations banned them decades ago due to concerns over masking injuries, while high school sports associations in the 2010s began explicitly prohibiting their use to prevent potential health risks among young athletes.^[19]^[31] In the NFL, a 2025 policy update barred teams from supplying smelling salts, citing their potential to obscure concussion symptoms, though players may still use personal supplies.^[8]

Risks and Safety

Potential Side Effects

The use of smelling salts, which release ammonia gas, can lead to acute irritation of the respiratory tract and mucous membranes upon inhalation. Common immediate reactions include nasal burning, excessive tearing, and coughing, as the ammonia irritates sensory nerves in the nose and eyes. In rare instances, direct skin contact with concentrated liquid forms may cause chemical burns, particularly if the substance is mishandled or broken open improperly.^[21]^[19] Systemic effects may occur shortly after use, including headaches, nausea, dizziness, and vomiting, resulting from the reflexive increase in heart rate and blood pressure. The inhalation reflex can also induce hyperventilation, potentially leading to lightheadedness or fainting in susceptible individuals. These symptoms typically resolve quickly but can be more pronounced in those with pre-existing sensitivities.^[7]^[19] Overuse or repeated exposure carries risks of medium-term respiratory inflammation, with documented cases linking chronic inhalation to bronchitis-like symptoms or pulmonary edema. A notable allergic reaction in a powerlifter involved rhinitis, wheezing, shortness of breath, and periorbital edema shortly after use, requiring treatment with epinephrine and antihistamines. Recent FDA reports from 2024 highlight similar respiratory issues, including airway constriction and throat irritation, in consumers of unapproved ammonia inhalants.^[6]^[7] Overall incidence of severe adverse effects remains low, with FDA data show 6 adverse event reports in 2022, 26 in 2023, and 2 as of August 2024, indicating low but varying annual reports; incidence rates among users are unknown due to lack of comprehensive usage data. however, risks appear elevated in unsupervised athletic contexts where frequent or improper application is common.^[32]^[7]

Contraindications and Precautions

Smelling salts, primarily composed of ammonia compounds, are contraindicated for individuals with asthma or other chronic respiratory conditions, as the irritant vapors can trigger bronchospasm, exacerbate breathing difficulties, and potentially lead to severe airway constriction.^[19]^[2]^[5]^[21]^[33]^[34] Pregnant individuals should avoid exposure to smelling salts due to insufficient data on the safety of ammonia inhalation during pregnancy, with recommendations to minimize unnecessary chemical exposures.^[35] Children, particularly those under 2 years of age, are at heightened risk of irritation and adverse reactions, and use is generally not advised without medical supervision.^[36]^[33] To minimize risks, smelling salts should be limited to 1-2 brief inhalations per use, held at a safe distance from the nose to avoid excessive irritation.^[37] They must be avoided in cases of head trauma or suspected concussion, as the stimulating effect can mask symptoms and complicate injury assessment, potentially leading to worsened outcomes.^[5]^[1]^[38]^[39] For storage, keep them in a cool, dry place at room temperature, sealed in their original container and away from heat sources or moisture to prevent premature decomposition and maintain potency.^[19]^[40]^[41] Guidelines for in-flight medical care, endorsed by the American College of Emergency Physicians, recommend against including ammonia inhalants in first aid kits due to limited evidence of benefit and potential for harm. In general emergency settings, safer revival methods are prioritized.^[42] In sports, organizations like the NCAA permit smelling salts as they are not listed among banned substances, but usage is monitored to ensure it does not contribute to injury oversight or overuse. As of August 2025, the NFL has advised against the use of smelling salts due to potential health risks highlighted by FDA warnings.^[43]^[44]^[45]^[46] Safer alternatives include oxygen therapy for medical revival in cases of syncope or low alertness, which provides respiratory support without irritants.^[36] For milder stimulation in sports or daily use, menthol-based inhalers, such as those containing camphor and essential oils, offer a non-ammonia option to enhance focus and breathing without the risks of chemical irritation.^[47]^[48]

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