Ammonium chloride increases the blood acidity and decreases the PH. It is used in the treatment of hypochloremic states or metabolic alkalosis.

Ammonium chloride Dose in Adults

• Dosing of mEq NH4Cl via the chloride-deficit method in patients with hypochloremia):

  • Dose of mEq NH4Cl = [0.2 L/kg x body weight (kg)] x [103 - observed serum chloride]
  • Administer 50% of the calculated dose over 12 - 24 hours or
  • administer the entire calculated dose over 12 - 24 hours and then re-evaluate.

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• Dosing of mEq NH4Cl via the bicarbonate-excess method in patients with refractory hypochloremic metabolic alkalosis:
  • Dose of mEq NH4Cl = [0.5 L/kg x body weight (kg)] x (observed serum HCO3- 24).
  • Administer 50% of dose over 12 - 24 hours and then re-evaluate

Ammonium chloride Dose in Childrens

For the treatment of Metabolic alkalosis: 

• Infants, Children, and Adolescents:
  • Dosing of mEq NH4Cl via the chloride-deficit method in hypochloremia:
    • NH4Cl = 0.2 L/kg x wt in kg x [103 - serum Cl ] mEq/L
  • Dosing of mEq NH4Cl via the bicarbonate-excess method in refractory hypochloremic metabolic alkalosis:
    • mEq NH4Cl = 0.5 L/kg x wt in kg x [serum HCO - 24] mEq/L
  • Dosing of mEq NH4Cl via the base excess method:
    • mEq NH4Cl = 0.3 L/kg x wt in kg x base excess in mEq/L

Pregnancy Risk Factor C

• It has not been studied in pregnancy and lactation.
• It shoud be avoided.

Ammonium chloride Dose in Renal Disease:

• Mild-to-moderate impairment:
  • Use with caution in mild to moderate renal disease.
  • Adjustment in the dose has not been provided in the manufacturer labeling.
• Severe impairment:
  • Use is contraindicated.

Ammonium chloride Dose in Liver Disease:

• Mild-to-moderate hepatic impairment:
  • Use with caution.
  • Adjustment in the dose has not been provided in the manufacturer labeling.
• Severe impairment:
  • Use is contraindicated.

Side Effects of Ammonium Chloride Frequency not defined.

• Central nervous system:
  • Coma
  • Confusion
  • Seizure
• Endocrine & metabolic:
  • Hypervolemia
• Local:
  • Extravasation
  • Injection site infection
  • Injection site phlebitis
  • Pain at the injection site
  • Venous thrombosis at the injection site
• Miscellaneous:
  • Fever

Contraindication to Ammonium Chloride Include:

• Grave liver disease.
• Severe kidney dysfunction
• Patients with metabolic alkalosis should avoid vomiting.

Warnings and Precautions

• Ammonia toxicity:
  • Ammonia toxicities can cause patients to experience pallor, sweating and altered breathing.
• Hepatic impairment
  • Hepatic Encephalopathy may be caused by an increase in ammonia levels.
  • It is contraindicated for severe hepatic impairment.
• Renal impairment
  • This may cause an increase in the concentration of urea and should be avoided in mild to moderate renal impairment.
  • It is not recommended for severe renal impairment.
• Respiratory disease
  • Patients suffering from respiratory acidosis and insufficiency need to be cautious when using the drug.

Ammonium chloride: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitor

• Serum bicarbonate
• Clinical features of ammonia toxicity

How to administer  Ammonium Chloride?

• Intravenous:
  • It should be administered by slow intravenous infusion to avoid local irritation and adverse effects.
  • In adults, the rate of infusion should not exceed 5 mL/minute.

Mechanism of action of Ammonium Chloride:

It decreases blood PH (increases acidity) by increasing free hydrogen ion concentration.

It isMetabolizedThe liver converts urea into hydrochloric acid, and isexcretedPrimarily in the urine.

International Brands:

• Ammonium Chloride Intravenous

Ammonium Chloride in Pakistan: