Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 5 mEq/mL
Hypochloremic States & Metabolic Alkalosis
mEq of chloride ion (as ammonium chloride-NH4Cl) = [0.2 L/kg X BW (kg)] X [103 - observed serum chloride]; administer 50% of dose over 12 hr and reevaluate
103 is the average normal serum chloride concentration (mEq/L) and 0.2 L/kg is the estimated chloride volume of distribution
Dosage Forms & Strengths
injectable solution
- 5 mEq/mL
Hypochloremic States & Metabolic Alkalosis
mEq of chloride ion (as ammonium chloride-NH4Cl) = [0.2 L/kg X BW (kg)] X [103 - observed serum chloride]; administer 50% of dose over 12 hr and reevaluate
103 is the average normal serum chloride concentration (mEq/L) and 0.2 L/kg is the estimated chloride volume of distribution
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (0)
Monitor Closely (6)
- dextroamphetamine
ammonium chloride decreases levels of dextroamphetamine by increasing renal clearance. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and ammonium chloride both decrease serum potassium. Use Caution/Monitor.
dichlorphenamide, ammonium chloride. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis. - lisdexamfetamine
ammonium chloride decreases levels of lisdexamfetamine by increasing renal clearance. Use Caution/Monitor.
- methamphetamine
ammonium chloride decreases levels of methamphetamine by increasing renal clearance. Use Caution/Monitor.
- methylenedioxymethamphetamine
ammonium chloride decreases levels of methylenedioxymethamphetamine by increasing renal clearance. Use Caution/Monitor.
- pseudoephedrine
ammonium chloride decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.
Minor (1)
- spironolactone
spironolactone, ammonium chloride. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of systemic acidosis.
Adverse Effects
Frequency Not Defined
Metabolic acidosis
Rash
EEG abnormalities
Seizure
Mental confusion
Drowsiness
Injection site reactions
Ammonia toxicity symptoms
Calcium-deficient tetany
Hypokalemia
Hyperchloremia
Abdominal pain
Nausea/vomiting
Hyperventilation
Warnings
Contraindications
Severe hepatic or renal impairment
Cautions
Pulmonary insufficiency, cardiac edema, severe renal impairment (do not give NH4Cl alone if concomitant Na loss)
Risk of ammonia toxicity (monitor)
Monitor patients CO2 combining power prior to IV administration to avoid serious acidosis
Pregnancy & Lactation
Pregnancy Category: C
Lactation: N/A
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Increases acidity by increasing the amount of hydrogen ion concentrations
Pharmacokinetics
Metabolism: Ammonium ion is converted to urea in the liver; chloride ion replaces bicarbonate
Excretion: Urine
Administration
IV Incompatibilities
Additive: dimenhydrinate(?), levorphanol
Y-site: warfarin(?)
IV Preparation
Must dilute the 26.75% (5 mEq/mL) concentrate by adding 100 or 200 mEq (20 or 40 mL) of NH4Cl to 500 or 1000 mL of NS
IV Administration
Not to exceed infusion rate of 5 mL/min in adults
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Formulary
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