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If you are looking for a stronger household cleaner, be wary of mixing your own.

Doctors in Arizona reported in today's New England Journal of Medicine on the case of a 53-year-old worker who nearly died when she mixed bleach with an over-the-counter liquid cleaner and inhaled the fumes while wiping down a walk-in freezer.

The woman's throat became so swollen doctors had to perform an emergency tracheotomy, slitting her windpipe to allow her to breathe. She was hospitalized for seven days.

In a letter to the Journal, Dr. David Tanen and his colleagues at Good Samaritan Regional Medical Center in Phoenix said the combination of ammonia and bleach releases chloramine gas, which can react with the moisture in the throat to release ammonia, hydrochloric acid and free radicals.

"Although it occurs infrequently, exposure to chloramine gas represents a substantial risk when household cleaners containing bleach and ammonia are mixed," they wrote.

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