Pronunciation: Online audio
IV: Treatment of:
- Hypochloremic states,
- Metabolic alkalosis.
Ammonium ion is converted to urea in the liver, liberating hydrogen and chloride.
Decreased pH and correction of metabolic alkalosis.
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.
TIME/ACTION PROFILE (effect on serum electrolytes)
|IV||rapid||end of infusion||unknown|
Use Cautiously in:
- Primary respiratory acidosis
- OB: /Lactation: Safety not established.
Adverse Reactions/Side Effects
CNS: coma, confusion, drowsiness,, headache,, seizure
GI: hypokalemia, gastric irritation, nausea, vomiting
F and E: metabolic acidosis
Local: pain/irritation at IV site
Metabolic: ammonia toxicity
* CAPITALS indicate life-threatening.
Italics indicate most frequent.
Will hasten excretion of basic drugs (amphetamines, quinidine).
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 (generic available)
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
- 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.
Monitor for symptoms of ammonia toxicity (pallor, sweating, retching, bradycardia, arrhythmias, hyperventilation, local and general twitching, tonic convulsions, coma).
- Continuous InfusionDiluent: 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.
Explain purpose of therapy to patient.
Resolution of hypochloremia or metabolic alkalosis.
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