ammonium chloride

Ammonium chloride is an acidifying agent administered intravenously to treat metabolic alkalosis and low chloride levels (hypochloremia).

Metabolic alkalosis is a condition with high alkalinity of body fluids, due to excessive bicarbonate levels in blood. Metabolic alkalosis may result from acid and fluid loss from prolonged vomiting or diuretic use, or from low blood potassium level (hypokalemia) which impairs the kidney’s ability to excrete bicarbonate.

Ammonium chloride increases systemic and urinary acidity and restores normal acid-base balance in the body. Normal pH levels in the body range between 7.35 and 7.45, and maintaining this ratio is essential for proper functioning of every organ in the body and to maintain biological equilibrium (homeostasis). If the pH levels fall below the range, it is considered too acidic and pH levels higher than the normal range are too alkaline.

Ammonium ions play an important role in maintaining the acid-base ratio. The liver metabolizes ammonium chloride into urea and hydrogen chloride. The hydrogen ions react with bicarbonate to form water and carbon dioxide, and the chloride ions take the place of bicarbonate ions in the extracellular fluid, increasing chloride levels. Ammonium chloride may be administered until the normal acid-base ratio is restored.

• Do not administer ammonium chloride to patients with impaired liver or kidney function. The liver metabolizes ammonium chloride and the kidney excretes the metabolites.
• Monitor patients for ammonia toxicity, which can cause pallor, sweating, irregular breathing, irregular heart rhythms and may lead to convulsions and coma.
• Before administering ammonium chloride, monitor the patient’s carbon dioxide combining power, which is the ability of blood plasma to combine with carbon dioxide. If this is low, it can lead to serious acidosis.
• Administer ammonium chloride with caution in patients with the following conditions:
  • Pulmonary insufficiency
  • Cardiac edema
• Do not administer ammonium chloride alone if there is also concurrent sodium loss in patients with severe kidney impairment.

Common side effects of ammonium chloride include:

• Metabolic acidosis
• Ammonia toxicity symptoms
• Rapid breathing (hyperventilation)
• EEG abnormalities
• Involuntary muscle contractions due to electrolyte imbalance (calcium-deficient tetany)
• Seizure
• Mental confusion
• Drowsiness
• Injection site reactions
• Rash
• Low blood potassium levels (hypokalemia)
• High blood chloride levels (hyperchloremia)
• Abdominal pain
• Nausea
• Vomiting

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Injectable Solution

• 5 mEq/mL

Adult and Pediatric:

Hypochloremic States and 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 hours and reevaluate
• 103 is the average normal serum chloride concentration (mEq/L) and 0.2 L/kg is the estimated chloride volume of distribution

• Patients administered ammonium chloride should be carefully monitored to avoid metabolic acidosis and ammonia toxicity.
• Ammonium chloride overdose can cause excessive acidity of body fluids (metabolic acidosis) resulting in disorientation, confusion and coma.
• Ammonium chloride overdose can also result in ammonia toxicity which can cause irregular breathing, irregular heart rhythm, convulsions and coma.
• Metabolic acidosis can be reversed by administration of an alkalinizing solution such as sodium bicarbonate or sodium lactate. Ammonia toxicity may be treated with appropriate supportive and symptomatic care.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Ammonium Chloride has no known severe or serious interactions with other drugs.
• Moderate interactions of ammonium chloride include:
  • dextroamphetamine
  • dichlorphenamide
  • lisdexamfetamine
  • methamphetamine
  • methylenedioxymethamphetamine
  • pseudoephedrine
• Mild interactions of ammonium chloride include:
  • spironolactone

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• There are no adequate well-controlled studies on administration of ammonium chloride during pregnancy. Use only if maternal benefits clearly outweigh fetal risks.
• There is no information available on the use of ammonium chloride in nursing mothers.