Davis's Drug Guide

ammonium chloride

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)

ROUTEONSETPEAKDURATION
IVrapidend of infusionunknown

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



Lab Test Considerations

• Monitor serum bicarbonate levels to determine dose

» Monitor arterial blood gases



Toxicity and Overdose

• 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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