General

Pronunciation
a-MONE-ee-yum KLOR-ide

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)

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): The dose of ammonium chloride should be determined 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 patient for signs of metabolic alkalosis (hypoventilation) during therapy

• Monitor patient for signs of hepatic function impairment (ammonia retention with intoxication, hepatic coma), especially in patients with uremia, cirrhosis, or hepatitis

• Monitor serum bicarbonate levels to determine dose

» Monitor arterial blood gases

• Monitor patient 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

• Continuous Infusion: Add contents of 1–2 vials (100–200 mEq) to 500 or 1000 ml of 0.9% NaCl, not to 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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