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Indications and Dosage
Intravenous
Hypochloraemia, Metabolic alkalosis Adult: Dosage depends on severity of the condition and tolerance of the patient. Dose may also be determined based on the carbon dioxide combining power level and chloride deficit. Refer to product information for detailed guideline.
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Renal Impairment
Severe: Contraindicated.
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Hepatic Impairment
Severe: Contraindicated.
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Reconstitution
Dilute vial containing 5 mEq/mL with NaCl 0.9% solution to provide a final concentration not to exceed 1% - 2% ammonium chloride solution.
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Incompatibility
Incompatible with alkalis, carbonates and with lead and silver salts.
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Contraindications
Severe renal or hepatic impairment.
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Special Precautions
Patients with pulmonary insufficiency, cardiac oedema, primary respiratory acidosis. Not intended to be administered when metabolic alkalosis due to vomiting of hydrochloric acid is accompanied by loss of Na. Mild to moderate renal and hepatic impairment. Pregnancy.
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Adverse Reactions
Significant: Ammonia toxicity (e.g. pallor, diaphoresis, bradycardia, arrhythmia, retching, twitching).
General disorders and administration site conditions: Inj site reaction (e.g. pain, irritation, phlebitis, venous thrombosis, infection). Investigations: Acidosis, hypokalaemia, EEG abnormalities. Metabolism and nutritional disorders: Hyperglycaemia. Nervous system disorders: Headache, hyperreflexia. Psychiatric disorders: Hyperventilation, mental confusion. Renal and urinary disorders: Glycosuria. Skin and subcutaneous tissue disorders: Rash. |
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Monitoring Parameters
Monitor serum bicarbonate levels and carbon dioxide combining power blood level. Monitor for signs and symptoms of ammonia toxicity e.g. pallor, sweating, irregular breathing, vomiting.
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Overdosage
Symptoms: Metabolic acidosis, disorientation, confusion and coma. Management: Administration of an alkalinising solution such as Na bicarbonate or Na lactate to correct acidosis.
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Drug Interactions
May enhance the adverse effect with K-sparing diuretics. May increase the serum concentration of chlorpropamide, salicyclates. May decrease the serum concentration of amantadine, amphetamines, mecamylamine, α/β-agonists.
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Action
Description: Ammonium chloride is an electrolyte replenisher and systemic acidifier. It increases acidity by increasing free hydrogen ion concentration. The therapeutic effects depend upon the ability of the kidney to utilize ammonia in the excretion of an excess of fixed anions and the conversion of ammonia to urea by the liver, thereby liberating hydrogen and chloride ions into the extracellular fluid.
Pharmacokinetics: Absorption: Rapidly absorbed from gastrointestinal tract after oral administration. Metabolism: Metabolised in the liver to form urea and hydrochloric acid. Excretion: Via urine. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Ammonium chloride, CID=25517, https://pubchem.ncbi.nlm.nih.gov/compound/Ammonium-chloride (accessed on Jan. 20, 2020) |
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Storage
Store between 20-25°C.
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ATC Classification
B05XA04 - ammonium chloride ; Belongs to the class of electrolyte solutions used in I.V. solutions.
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References
Anon. Ammonium Chloride. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 01/08/2018. Anon. Ammonium Chloride. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/08/2018. Buckingham R (ed). Ammonium Chloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/08/2018.
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