General
Pronunciation
a-MONE-ee-yum KLOR-ide [Pronunciation]
Pregnancy Category
Category C
Ther. class.
electrolyte modifiers
Pharm. class.
acidifying agents
Indications
IV: Treatment of:
» Hypochloremic states,
» Metabolic alkalosis.
Action
Ammonium ion is converted to urea in the liver, liberating hydrogen and chloride.
Therapeutic Effect(s):
Decreased pH and correction of metabolic alkalosis.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability; completely absorbed after oral administration.
Distribution: Widely distributed.
Metabolism and Excretion: Ammonium ion is converted to urea in the liver, liberating hydrogen and chloride.
Half-life: Unknown.
TIME/ACTION PROFILE (effect on serum electrolytes)
| ROUTE | ONSET | PEAK | DURATION |
| IV | rapid | end of infusion | unknown |
Contraindication/Precautions
Contraindicated in:
Renal/hepatic impairment.
Use Cautiously in:
• Primary respiratory acidosis;
• OB: /Lactation: Safety not established.
Adverse Reactions/Side Effects
CNS: coma, confusion, drowsiness,, headache,, seizure.
Derm: rash.
GI: hypokalemia, gastric irritation, nausea, vomiting.
F and E: metabolic acidosis.
Local: pain/irritation at IV site.
Metabolic: ammonia toxicity.
MS: twitching.
Resp: hyperventilation.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Interactions
Drug-Drug
Will hasten excretion of basic drugs ( amphetamines , quinidine ).
Route/Dosage
• IV (Adults): Determine the dose of ammonium chloride by calculating the patient's chloride deficit. The following formula can be used to calculate the dosage of ammonium chloride (NH4Cl): Dose (mEq) = [0.2 L/kg * body weight (kg)] * [103–(patient's serum chloride)]. 50% of this dose should be administered initially and then the patient should be reevaluated. The need for additional doses should be determined after evaluation the patient's serum bicarbonate..
Availability
• Solution for injection (for dilution): Ammonium 5 mEq/mL(chloride 5 mEq/mL) (equivalent to ammonium chloride 267.5 mg/mL) in 20-mL vials
Assessment
• Assess for signs of metabolic alkalosis (hypoventilation) during therapy.
• Monitor for signs of hepatic function impairment (ammonia retention with intoxication, hepatic coma), especially in patients with uremia, cirrhosis, or hepatitis.
Lab Test Considerations
• Monitor serum bicarbonate levels to determine dose.
» Monitor arterial blood gases.
Toxicity and Overdose• Monitor for symptoms of ammonia toxicity (pallor, sweating, retching, bradycardia, arrhythmias, hyperventilation, local and general twitching, tonic convulsions, coma).
Potential Nursing Diagnoses
• Deficient knowledge , related to medication regimen (Patient/Family Teaching)
Implementation
IV Adminstration:
• Continuous Infusion:
Diluent: Add contents of 1–2 vials (100–200 mEq) to 500 or 1000 mL of 0.9% NaCl.
Concentration: Do not exceed a concentration of 1–2% ammonium chloride. Do not freeze. If crystals form, warm solution to room temperature in a water bath before use.
• Rate:
Administer by slow infusion, not to exceed 5 mL/min (approximately 3 hr for 1000 mL) in adults. Rapid administration may cause pain, toxic effects, and local irritation at venipuncture site and along course of vein.
Patient/Family Teaching
Explain purpose of therapy to patient.
Evaluation/Desired Outcomes
Resolution of hypochloremia or metabolic alkalosis.
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