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Pronunciation:

(a MOE nee um KLOR ide)

Generic Available:

Yes

Use:

Treatment of hypochloremic states or metabolic alkalosis

Pregnancy Risk Factor:

Pregnancy Implications:

Reproduction studies have not been conducted.

Contraindications:

Severe hepatic or renal dysfunction

Warnings/Precautions:

Use caution in patients with primary respiratory acidosis or pulmonary insufficiency. Safety and efficacy have not been established in children.

Adverse Reactions:

Frequency not defined.

Central nervous system: Headache, coma, drowsiness, EEG abnormalities, mental confusion, seizure

Dermatologic: Rash

Endocrine & metabolic: Calcium-deficient tetany, hyperchloremia, hypokalemia, metabolic acidosis, potassium and sodium may be decreased

Gastrointestinal: Abdominal pain, gastric irritation, nausea, vomiting

Hepatic: Ammonia may be increased

Local: Pain at site of injection

Neuromuscular & skeletal: Twitching

Respiratory: Hyperventilation

Overdosage/Toxicology:

Symptoms of overdose include abdominal pain, apnea, bradycardia, confusion, coma, diuresis, headache, hyperchloremic hypokalemic metabolic acidosis, hyperventilation, hypomagnesemia, hypovolemia, nausea, pulmonary edema, seizures, vomiting. Administer electrolytes as indicated.

Stability:

Prior to use, vials should be stored at controlled room temperature of 15°C to 30°C (59°F to 86°F). Solution may crystallize if exposed to low temperatures. If crystals are observed, warm vial to room temperature in a water bath prior to use. Dilute prior to use; final concentration should not exceed 1% to 2% ammonium chloride. Suggested dilution: Mix contents of 1-2 vials (100-200 mEq) in 500-1000 mL NS.

Compatibility:

Stable in dextran 6% in D5W, dextran 6% in NS, D5LR, D5NS, D5¹/2NS, D5¹/4NS, D5W, D10W, LR, ¹/2NS, NS

Y-site administration: Variable (consult detailed reference): Warfarin

Compatibility when admixed: Incompatible: Levorphanol. Variable (consult detailed reference): Dimenhydrinate, potassium chloride

Mechanism of Action:

Increases acidity by increasing free hydrogen ion concentration

Pharmacodynamics/Kinetics:

Metabolism: Hepatic; forms urea and hydrochloric acid

Excretion: Urine

Dosage:

Metabolic alkalosis: The following equations represent different methods of correction utilizing either the serum HCO3^-, the serum chloride, or the base excess

Dosing of mEq NH4Cl via the chloride-deficit method (hypochloremia):

Dose of mEq NH4Cl = [0.2 L/kg x body weight (kg)] x [103 - observed serum chloride]; administer 50% of dose over 12 hours, then re-evaluate

Note: 0.2 L/kg is the estimated chloride volume of distribution and 103 is the average normal serum chloride concentration (mEq/L)

Dosing of mEq NH4Cl via the bicarbonate-excess method (refractory hypochloremic metabolic alkalosis):

Dose of NH4Cl = [0.5 L/kg x body weight (kg)] x (observed serum HCO3^- - 24); administer 50% of dose over 12 hours, then re-evaluate

Note: 0.5 L/kg is the estimated bicarbonate volume of distribution and 24 is the average normal serum bicarbonate concentration (mEq/L)

These equations will yield different requirements of ammonium chloride

Administration:

Administer by slow intravenous infusion to avoid local irritation and adverse effects. Rate of infusion should not exceed 5 mL/minute in an adult.

Monitoring Parameters:

Serum bicarbonate; signs and symptoms of ammonia toxicity

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause sedation and confusion

Mental Health: Effects on Psychiatric Treatment:

None reported

Dosage Forms:

Injection, solution: Ammonium 5 mEq/mL and chloride 5 mEq/mL (20 mL) [equivalent to ammonium chloride 267.5 mg/mL]

References

Martin WJ and Matzke GR, "Treating Severe Metabolic Alkalosis,"Clin Pharm, 1982, 1(1):42-8.

Megarbane B, Bruneel F, Bedos JP, et al, "Ammonium Chloride Poisoning: A Misunderstood Cause of Metabolic Acidosis With Normal Anion Gap,"Intensive Care Med, 2000, 26(12):1869.

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