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 the dose over 12 - 24 hours and then re-evaluate

Ammonium chloride Dose in Children

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 should be avoided.

Ammonium chloride Dose in Renal Disease:

• Low-to-medium 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

Contraindications 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
  • In people with mild to severe renal impairment, this should be avoided since it may raise the levels of urea.
  • For those with severe renal impairment, it is not advised.
• 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:
  • To prevent local irritability and negative effects, it should be supplied by a gradual intravenous infusion.
  • Adults should not receive more than 5 mL/minute of infusion.

Mechanism of action of Ammonium Chloride:

It does this by raising the concentration of free hydrogen ions, which lowers blood PH (increases acidity).

It is metabolized the liver converts urea into hydrochloric acid and is excreted primarily in the urine.

International Brands:

• Ammonium Chloride Intravenous

Ammonium Chloride in Pakistan: