| AMMONIUM CHLORIDE
Classifications: electrolytic balance agent; Therapeutic: acidfier; electrolyte replacement
Pregnancy Category: B
26.75% or 5 mEq/mL solution; 500 mg tablets; 486 mg enteric-coated tablets
Acidifying property is due to conversion of ammonium ion (NH4+) to urea in liver with liberation of H+ and Cl. Potassium excretion also increases acid, but to a lesser extent.
Effective as a systemic acidifier in metabolic alkalosis by releasing H+ ions which lower pH.
Treatment of hypochloremic states and metabolic alkalosis. Diuretic or urinary acidifying agent.
Severe renal or hepatic insufficiency; primary respiratory acidosis.
Cardiac edema, cardiac insufficiency, pulmonary insufficiency; pregnancy (category B), lactation.
Route & Dosage
|Urine Acidifier, Diuretic
Adult: PO 412 g/d divided q46h
Child: PO 75 mg/kg/d in 4 divided doses
Metabolic Alkalosis and Hypochloremic States
Adult/Child: IV Dose calculated on basis of CO2 combining power or serum Cl deficit, 50% of calculated deficit is administered slowly
- Give after meals for best tolerance or use enteric-coated tablets. Tablets should be swallowed whole.
- Store in airtight container.
- Check with physician for slower rate for infants.
PREPARE: Intermittent: Dilute each 20 mL vial in 5001000 mL NS. Do not exceed a concentration of 12%.
ADMINISTER: Intermittent: Give slowly to avoid serious adverse effects (ammonia toxicity) and local irritation and pain. Give at a rate not to exceed
INCOMPATIBILITIES Solution/additive: Codeine phosphate, dimenhydrinate. Y-site: Warfarin.
- Avoid freezing.
- Concentrated solutions crystallize at low temperatures.
- Crystals can be dissolved by placing intact container in a warm water bath and warming to room temperature.
Adverse Effects (≥1%)Body as a Whole:
Most secondary to ammonia toxicity
, drowsiness, twitching, excitability; EEG abnormalities. CV:
Bradycardia and other arrhythmias. GI:
Gastric irritation, nausea, vomiting, anorexia. Metabolic:
Metabolic acidosis, hyperammonia. Respiratory:
Pain and irritation at IV
Diagnostic Test Interference
Ammonium chloride may increase blood ammonia and AST, decrease serum magnesium (by increasing urinary magnesium excretion), and decrease urine urobilinogen.
InteractionsDrug: Aminosalicylic acid
may cause crystalluria; increases urinary excretion of amphetamines
, flecainide, mexiletine, methadone, ephedrine, pseudoephedrine;
decreased urinary excretion of sulfonylureas
Completely absorbed in 36 h. Metabolism:
In liver to HCl and urea. Elimination:
Primarily in urine.
Assessment & Drug Effects
- Assess IV infusion site frequently for signs of irritation. Change site as warranted.
- Monitor for S&S of: metabolic acidosis (mental status changes including confusion, disorientation, coma, respiratory changes
including increased respiratory rate and depth, exertional dyspnea); ammonium toxicity (cardiac arrhythmias including bradycardia,
irregular respirations, twitching, seizures).
- Monitor I&O ratio and pattern. The diuretic effect of ammonium chloride is compensatory and lasts only 12 d.
- Lab tests: Baseline and periodic determinations of CO2 combining power, serum electrolytes, and urinary and arterial pH during therapy to avoid serious acidosis.
Patient & Family Education
- Report pain at IV injection site.