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Name /bks_53161_deglins_md_disk/ammoniumchloride 02/20/2014 02:33PM 1 ammonium chloride (a-mone-ee-yum klor-ide) Classification Therapeutic: electrolyte modifiers Pharmacologic: acidifying agents Pregnancy Category C pg 1 # 1 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. PDF Page #1 Name /bks_53161_deglins_md_disk/ammoniumchloride 02/20/2014 02:33PM Plate # 0-Composite pg 2 # 2 2 PDF Page #2 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? 䉷 2015 F.A. Davis Company