Look Up > Drugs > Ammonium Chloride
Ammonium Chloride
Pronunciation
Generic Available
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Administration
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(a MOE nee um KLOR ide)

Generic Available

Yes


Pharmacological Index

Electrolyte Supplement, Parenteral; Urinary Acidifying Agent


Use

Diuretic or systemic and urinary acidifying agent; treatment of hypochloremic states


Pregnancy Risk Factor

C


Contraindications

Severe hepatic and renal dysfunction; patients with primary respiratory acidosis


Warnings/Precautions

Safety and efficacy not established in children, use with caution in infants


Adverse Reactions

Percentage unknown: Mental confusion, coma, headache (with large doses), rash, metabolic acidosis, hyperchloremia, hypokalemia (with large doses), gastric irritation, nausea, vomiting, pain at site of injection, hyperventilation (with large doses), may increase ammonia, may decrease potassium and sodium


Overdosage/Toxicology

Symptoms of overdose include acidosis, headache, drowsiness, confusion, hyperventilation, hypokalemia

Administer sodium bicarbonate or lactate to treat acidosis; supplemental potassium for hypokalemia


Stability

Avoid excessive heat; protect from freezing (will precipitate crystals); if crystals form, warm at room temperature in water bath; compatible with normal saline


Mechanism of Action

Increases acidity by increasing free hydrogen ion concentration


Pharmacodynamics/Kinetics

Absorption: Rapid from GI tract, complete within 3-6 hours

Metabolism: In the liver

Elimination: In urine


Usual Dosage

Metabolic alkalosis: The following equations represent different methods of correction utilizing either the serum HCO3-, the serum chloride, or the base excess

Dose of mEq NH4Cl = [0.2 L/kg x body weight (kg)] x [103 - observed serum chloride]; administer 100% of dose over 12 hours, then re-evaluate

Note: 0.2 L/kg is the estimated chloride space and 103 is the average normal serum chloride concentration

Dosing of mEq NH4 Cl via the bicarbonate-excess method (refractory hypochloremic metabolic alkalosis):

Dose of NH4Cl = [0.5 L/kg x body weight (kg)] x (observed serum HCO3- - 24); administer 50% of dose over 12 hours, then re-evaluate

Note: 0.5 L/kg is the estimated bicarbonate space and 24 is the average normal serum bicarbonate concentration

Dosing of mEq NH4 Cl via the base-excess method:

Dose of NH4Cl = [0.3 L/kg x body weight (kg)] x measured base excess (mEq/L); administer 50% of dose over 12 hours, then re-evaluate

Note: 0.3 L/kg is the estimated extracellular bicarbonate and base excess is measured by the chemistry lab and reported with arterial blood gases

These equations will yield different requirements of ammonium chloride

Equation #1 is inappropriate to use if the patient has severe metabolic alkalosis without hypochloremia or if the patient has uremia

Equation #3 is the most useful for the first estimation of ammonium chloride dosage

Children: Urinary acidifying agents: Oral, I.V.: 75 mg/kg/day in 4 divided doses; maximum daily dose: 6 g

Adults: Urinary acidifying agent/diuretic:

Oral: 1-2 g every 4-6 hours

I.V.: 1.5 g/dose every 6 hours


Administration

Dilute to 0.2 mEq/mL and infuse I.V. over 3 hours; maximum concentration: 0.4 mEq/mL; maximum rate of infusion: 1 mEq/kg/hour


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Take oral dose after meals


Nursing Implications

Rapid I.V. injection may increase the likelihood of ammonia toxicity; dilute to 0.2 mEq/mL and infuse I.V. over 3 hours; maximum concentration: 0.4 mEq/mL; maximum rate of infusion: 1 mEq/kg/hour

Monitor serum electrolytes, serum ammonia


Dosage Forms

Injection: 26.75% [5 mEq/mL] (20 mL)

Tablet: 500 mg

Tablet, enteric coated: 486 mg


References

Bushinsky DA and Coe FL, "Hyperkalemia During Acute Ammonium Chloride Acidosis in Man," Nephron, 1985, 40(1):38-40.


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