Ammonium Chloride

Pronunciation

(a MOE nee um KLOR ide)

Generic Available

Yes

Use

Treatment of hypochloremic states or metabolic alkalosis

Pregnancy Risk Factor

Pregnancy Implications

Reproduction studies have not been conducted.

Contraindications

Severe hepatic or renal dysfunction

Warnings/Precautions

Use caution in patients with primary respiratory acidosis or pulmonary insufficiency. Safety and efficacy have not been established in children.

Adverse Reactions

Frequency not defined.

Central nervous system: Headache, coma, drowsiness, EEG abnormalities, mental confusion, seizure

Dermatologic: Rash

Endocrine & metabolic: Calcium-deficient tetany, hyperchloremia, hypokalemia, metabolic acidosis, potassium and sodium may be decreased

Gastrointestinal: Abdominal pain, gastric irritation, nausea, vomiting

Hepatic: Ammonia may be increased

Local: Pain at site of injection

Neuromuscular & skeletal: Twitching

Respiratory: Hyperventilation

Overdosage/Toxicology

Symptoms of overdose include abdominal pain, apnea, bradycardia, confusion, coma, diuresis, headache, hyperchloremic hypokalemic metabolic acidosis, hyperventilation, hypomagnesemia, hypovolemia, nausea, pulmonary edema, seizures, vomiting. Administer electrolytes as indicated.

Stability

Prior to use, vials should be stored at controlled room temperature of 15°C to 30°C (59°F to 86°F). Solution may crystallize if exposed to low temperatures. If crystals are observed, warm vial to room temperature in a water bath prior to use. Dilute prior to use; final concentration should not exceed 1% to 2% ammonium chloride. Suggested dilution: Mix contents of 1-2 vials (100-200 mEq) in 500-1000 mL NS.

Compatibility

Stable in dextran 6% in D5W, dextran 6% in NS, D5LR, D5NS, D5¹ /2NS, D5¹ /4NS, D5W, D10W, LR, ¹ /2NS, NS

Y-site administration: Variable (consult detailed reference): Warfarin

Compatibility when admixed: Incompatible: Levorphanol. Variable (consult detailed reference): Dimenhydrinate, potassium chloride

Mechanism of Action

Increases acidity by increasing free hydrogen ion concentration

Pharmacodynamics/Kinetics

Metabolism: Hepatic; forms urea and hydrochloric acid

Excretion: Urine

Dosage

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

Dosing of mEq NH 4 Cl via the chloride-deficit method (hypochloremia):

Dose of mEq NH4Cl = [0.2 L/kg x body weight (kg)] x [103 - observed serum chloride]; administer 50% of dose over 12 hours, then re-evaluate

Note: 0.2 L/kg is the estimated chloride volume of distribution and 103 is the average normal serum chloride concentration (mEq/L)

Dosing of mEq NH 4 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 volume of distribution and 24 is the average normal serum bicarbonate concentration (mEq/L)

These equations will yield different requirements of ammonium chloride

Administration

Administer by slow intravenous infusion to avoid local irritation and adverse effects. Rate of infusion should not exceed 5 mL/minute in an adult.

Monitoring Parameters

Serum bicarbonate; signs and symptoms of ammonia toxicity

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause sedation and confusion

Mental Health: Effects on Psychiatric Treatment

None reported

Dosage Forms

Injection, solution: Ammonium 5 mEq/mL and chloride 5 mEq/mL (20 mL) [equivalent to ammonium chloride 267.5 mg/mL]

References

Martin WJ and Matzke GR, "Treating Severe Metabolic Alkalosis," Clin Pharm , 1982, 1(1):42-8.

Megarbane B, Bruneel F, Bedos JP, et al, "Ammonium Chloride Poisoning: A Misunderstood Cause of Metabolic Acidosis With Normal Anion Gap," Intensive Care Med , 2000, 26(12):1869.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Home > Medical Reference > Complementary Medicine