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ammonium chloride (a-mone-ee-yum klor-ide)
Classification
Therapeutic: electrolyte modifiers
Pharmacologic: acidifying agents
Pregnancy Category C
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Interactions
Drug-Drug: Will hasten excretion of basic drugs (amphetamines, quinidine).
Route/Dosage
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.
Indications
IV: Treatment of: Hypochloremic states, Metabolic alkalosis.
Action
Ammonium ion is converted to urea in the liver, liberating hydrogen and chloride.
Therapeutic Effects: 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.
NURSING IMPLICATIONS
Assessment
● Assess for signs of metabolic alkalosis (hypoventilation) during therapy.
● Monitor for signs of hepatic function impairment (ammonia retention with intoxi-
cation, 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 for symptoms of ammonia toxicity (pallor,
sweating, retching, bradycardia, arrhythmias, hyperventilation, local and general
twitching, tonic convulsions, coma).
Half-life: Unknown.
TIME/ACTION PROFILE (effect on serum electrolytes)
ROUTE
ONSET
PEAK
DURATION
IV
rapid
end of infusion
unknown
Contraindications/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. Metab: ammonia toxicity. MS: twitching. Resp: hyperventilation.
⫽ Canadian drug name.
Plate # 0-Composite
⫽ Genetic Implication.
Potential Nursing Diagnoses
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
IV Administration
● Continuous Infusion: Diluent: 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.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Patient/Family Teaching
● Explain purpose of therapy to patient.
Evaluation/Desired Outcomes
● Resolution of hypochloremia or metabolic alkalosis.
Why was this drug prescribed for your patient?
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