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1 Interactions
Drug-Drug: Will hasten excretion of basic drugs (amphetamines, quinidine). PDF Page #1
ammonium chloride (a-mone-ee-yum klor-ide)
Classification Route/Dosage
Therapeutic: electrolyte modifiers IV (Adults): Determine the dose of ammonium chloride by calculating the patient’s
Pharmacologic: acidifying agents chloride deficit. The following formula can be used to calculate the dosage of ammo-
nium chloride (NH4Cl): Dose (mEq) ⫽ [0.2 L/kg * body weight (kg)] * [103– (pa-
Pregnancy Category C tient’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 deter-
Indications mined after evaluation the patient’s serum bicarbonate.
IV: Treatment of: Hypochloremic states, Metabolic alkalosis.
NURSING IMPLICATIONS
Action
Ammonium ion is converted to urea in the liver, liberating hydrogen and chloride. Assessment
Therapeutic Effects: Decreased pH and correction of metabolic alkalosis. ● Assess for signs of metabolic alkalosis (hypoventilation) during therapy.
● Monitor for signs of hepatic function impairment (ammonia retention with intoxi-
Pharmacokinetics cation, hepatic coma), especially in patients with uremia, cirrhosis, or hepatitis.
Absorption: IV administration results in complete bioavailability; completely ab- ● Lab Test Considerations: Monitor serum bicarbonate levels to determine
sorbed after oral administration. dose.
Distribution: Widely distributed. ● Monitor arterial blood gases.
Metabolism and Excretion: Ammonium ion is converted to urea in the liver, ● Toxicity and Overdose: Monitor for symptoms of ammonia toxicity (pallor,
liberating hydrogen and chloride. sweating, retching, bradycardia, arrhythmias, hyperventilation, local and general
Half-life: Unknown. twitching, tonic convulsions, coma).
TIME/ACTION PROFILE (effect on serum electrolytes)
ROUTE ONSET PEAK DURATION Potential Nursing Diagnoses
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
IV rapid end of infusion unknown
Implementation
Contraindications/Precautions
Contraindicated in: Renal/hepatic impairment. IV Administration
Use Cautiously in: Primary respiratory acidosis; OB, Lactation: Safety not es- ● Continuous Infusion: Diluent: Add contents of 1– 2 vials (100– 200 mEq) to
tablished. 500 or 1000 mL of 0.9% NaCl. Concentration: Do not exceed a concentration
Adverse Reactions/Side Effects of 1– 2% ammonium chloride. Do not freeze. If crystals form, warm solution to
CNS: coma, confusion, drowsiness, headache, seizure. Derm: rash. GI: hypokale- room temperature in a water bath before use. Rate: Administer by slow infusion,
mia, gastric irritation, nausea, vomiting. F and E: metabolic acidosis. Local: pain/ not to exceed 5 mL/min (approximately 3 hr for 1000 mL) in adults. Rapid ad-
irritation at IV site. Metab: ammonia toxicity. MS: twitching. Resp: hyperventila- ministration may cause pain, toxic effects, and local irritation at venipuncture site
tion. and along course of vein.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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Patient/Family Teaching PDF Page #2
● 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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