Ammonium chloride is a chemical compound made up of ammonia and hydrogen chloride. It's often used in things like fertilizers, as a food additive, and in certain medical treatments. Sometimes, it's also used in things like dry cell batteries and as a flux in soldering.

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

• Ammonium Chloride Dosing of mEq NH4Cl via the chloride-deficit method in patients with hypochloremia):  
  • Dose of mEq NH4Cl = [0.2 L/kg × body weight (kg)] × [103 - observed serum chloride].
  • Here, 0.2 L/kg is the estimated volume where chloride is distributed in the body, and 103 is the average normal chloride level in the blood (measured in mEq/L).
  • After you calculate the dose, you can give either half of it or the full calculated dose over 12 to 24 hours, then check the person's condition again.
  • This helps to make sure they get the right amount without causing any problems.

• Ammonium Chloride Dosing of mEq NH4Cl via the bicarbonate-excess method in patients with refractory hypochloremic metabolic alkalosis:  
  • Dose of mEq NH4Cl = [0.5 L/kg × body weight (kg)] × (observed serum HCO3- 24).
  • In this equation, 0.5 L/kg represents the estimated volume in the body where bicarbonate is distributed, and 24 stands for the average normal bicarbonate level in the blood (measured in mEq/L).
  • After calculating the dose, administer 50% of it over 12 to 24 hours, and then check the patient's condition again to see if further treatment is needed.
  • This helps ensure the patient receives the appropriate amount of medication safely.

Ammonium chloride Dose in Children

Ammonium Chloride For the treatment of Metabolic alkalosis: 

• Metabolic Alkalosis in Infants, Children, and Adolescents:
  • Ammonium chloride is an alternative treatment and usually replaced by other acidic sources like hydrochloric acid or arginine. It should be used only after optimizing sodium and potassium chloride supplementation.
  • Different methods exist for correcting chloride or alkalosis levels, using serum chloride, serum bicarbonate, or base excess.
  • Initial dose typically ranges from a fraction to half of the calculated dose, then re-evaluate.

Intravenous Administration:

• Dosing via Chloride-Deficit Method (Hypochloremia):
  • Dose: mEq NH4Cl = 0.2 L/kg × weight (kg) × [103 - serum chloride (mEq/L)].
• Dosing via Bicarbonate-Excess Method (Refractory Hypochloremic Metabolic Alkalosis):
  • Dose: mEq NH4Cl = 0.5 L/kg × weight (kg) × [serum bicarbonate - 24 (mEq/L)].
• Dosing via Base Excess Method:
  • Dose: mEq NH4Cl = 0.3 L/kg × weight (kg) × base excess (mEq/L).

Oral Administration (Using Injectable Formulation):

• Very limited data available for infants and children.
• Initial dose calculated using applicable equation, then titrated based on response.
• In some cases, may need to administer up to 4 times daily.
• Due to potential differences in bioavailability between oral and intravenous routes, higher oral doses than calculated may be necessary.
• Monitor laboratory parameters closely.
• A case-series of 3 patients (ages: 6 weeks, 2 months, and 3 years) reported resolution of metabolic alkalosis in 2 patients within 4 to 8 days of therapy.
• Total weight-based dose required for resolution: 10.7 mEq/kg total and 18 mEq/kg total.
• No adverse effects from oral/NG-tube administration were reported.

Pregnancy Risk Factor C

• There haven't been any studies done on animals to see if this thing could affect pregnancy.

Ammonium chloride Dose in Renal Disease:

• Mild-to-Moderate Renal Impairment:
  • No dosage adjustments are mentioned in the manufacturer's instructions, but it's important to be cautious when using this medication.
• Severe Renal Impairment:
  • Using this medication is not allowed if someone has severe kidney problems; it's considered unsafe in such cases.

Ammonium chloride Dose in Liver Disease:

• Mild-to-Moderate Hepatic Impairment:
  • The manufacturer's instructions do not mention any dosage adjustments for individuals with mild-to-moderate liver problems. However, it's advised to use this medication cautiously in such cases.
• Severe Hepatic Impairment:
  • It's not recommended to use this medication if someone has severe liver problems; it's considered unsafe in such situations.

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:

• If someone has serious liver or kidney problems, or if they're experiencing metabolic alkalosis because they're vomiting hydrochloric acid along with losing sodium through urine, this medication shouldn't be given to them.
• It's not safe in these situations.

Warnings and Precautions

Ammonia toxicity:

• Keep a close watch for signs and symptoms of ammonia toxicity.
• These might include paleness, sweating, changes in breathing, slow heartbeat, irregular heart rhythms, retching, muscle twitching, seizures, and even falling into a coma.
• If you notice any of these signs, it's important to seek medical attention right away.

Hepatic impairment

• Liver problems can cause higher levels of ammonia in the body, which can make encephalopathy (a brain disorder) worse.
• Because of this risk, using this medication is not recommended for people with severe liver impairment.

Renal impairment

• If someone has kidney problems, it can lead to more urea being made in the body, which can make uremic symptoms worse.
• Due to this risk, it's not advised to use this medication for individuals with severe kidney impairment.

Respiratory disease

• It's important to be careful when using this medication in patients who have respiratory issues like primary respiratory acidosis or pulmonary insufficiency.

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:

• Pay attention to the level of bicarbonate in the blood.
• Changes in bicarbonate levels may indicate metabolic imbalances.
• Monitor closely for any significant fluctuations, especially in patients with metabolic alkalosis or acidosis.

Signs and Symptoms of Ammonia Toxicity:

• Watch out for signs like paleness, sweating, changes in breathing, slow heartbeat, irregular heart rhythms, retching, muscle twitching, seizures, and coma.
• If any of these symptoms occur, seek medical attention promptly.
• Monitoring for these signs is especially crucial in patients at risk of ammonia toxicity, such as those with liver or kidney problems.

How to administer Ammonium Chloride?

Intravenous Administration:

• Method: Administer through slow intravenous infusion to prevent irritation and unwanted effects.
• Rate Limit: Ensure the infusion rate doesn't surpass 5 mL per minute in adults to prevent complications.
• Duration: Some protocols suggest infusing the calculated dose over a span of 12 to 24 hours. This gradual approach helps in better tolerance and effectiveness of the treatment.

Mechanism of action of Ammonium Chloride:

• It increases acidity by boosting the number of free hydrogen ions in a solution.

Metabolism:

• Hepatic: Processed by the liver.
• Forms Urea and Hydrochloric Acid: It's broken down in the liver into urea and hydrochloric acid.

Excretion:

• Urine: The body eliminates it through urine.

Ammonium chloride International Brands:

• Ammonium Chloride Intravenous

Ammonium chloride brands in Pakistan: