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.

Therapeutic Effect

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.

Cautious Use

Cardiac edema, cardiac insufficiency, pulmonary insufficiency; pregnancy (category B), lactation.

Route & Dosage

Urine Acidifier, Diuretic
Adult: PO 4–12 g/d divided q4–6h
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 500–1000 mL NS. Do not exceed a concentration of 1–2%.  

ADMINISTER: Intermittent: Give slowly to avoid serious adverse effects (ammonia toxicity) and local irritation and pain. Give at a rate not to exceed 5 mL/min.  

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. CNS: Headache, depression, drowsiness, twitching, excitability; EEG abnormalities. CV: Bradycardia and other arrhythmias. GI: Gastric irritation, nausea, vomiting, anorexia. Metabolic: Metabolic acidosis, hyperammonia. Respiratory: Hyperventilation. Skin: Rash. Urogenital: Glycosuria. Other: Pain and irritation at IV site.

Diagnostic Test Interference

Ammonium chloride may increase blood ammonia and AST, decrease serum magnesium (by increasing urinary magnesium excretion), and decrease urine urobilinogen.


Drug: Aminosalicylic acid may cause crystalluria; increases urinary excretion of amphetamines, flecainide, mexiletine, methadone, ephedrine, pseudoephedrine; decreased urinary excretion of sulfonylureas, salicylates.


Absorption: Completely absorbed in 3–6 h. Metabolism: In liver to HCl and urea. Elimination: Primarily in urine.

Nursing Implications

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 1–2 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2022 Last Updated On: 11/28/2022 (0)
Wait 20 seconds...!!!