AMMONIUM CHLORIDE
(ah-mo’ni-um)
Classification: ELECTROLYTIC BALANCE AGENT
Therapeutic: ACIDFIER; ELECTROLYTE REPLACEMENT
Pregnancy Category: B
Availability: 26.75% or 5 mEq/mL solution
Action & Therapeutic Effect: Acidifying property is due to
conversion of ammonium ion (NH4+) to urea in liver with liberation of
H+ and Cl–. Potassium excretion also increases acid, but to a lesser
extent. Effective as a systemic acidifier in metabolic alkalosis by
releasing H+ ions which lower pH.
Uses: Treatment of hypochloremic states and metabolic alkalosis.
Contraindications: Severe renal or hepatic insufficiency; primary
respiratory acidosis.
Cautious Use: Cardiac edema, cardiac insufficiency, pulmonary
insufficiency; pregnancy (category B), lactation.
Route & Dosage
Metabolic Alkalosis and Hypochloremic States
Adult/Child: IV Dose calculated on basis of CO2 combining power or
serum Cl deficit, 50% of calculated deficit is administered slowly
Administration
Oral
Store in airtight container.
Common adverse effects in italic, life-threatening effects underlined; generic names
in bold; classifications in SMALL CAPS; Canadian drug name; Pr Prototype drug
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Ammonium Chloride. In Pearson Nurse's
Drug Guide 2012 (pp. 80–81). Upper Saddle River, NJ: Prentice Hall. 1
Intravenous
Check with prescriber for slower rate for infants.
Prepare: Intermittent: Dilute each 20 mL vial in 500–1000 mL NS.
Do not exceed a concentration of 1–2%.
Administer: Intermittent: Give slowly to avoid serious adverse
effects (ammonia toxicity) and local irritation and pain. • Give at a rate
not to exceed 5 mL/min.
Incompatibilities: Solution/additive: Codeine phosphate,
dimenhydrinate. Y-site: Warfarin.
• Avoid freezing. • Concentrated solutions crystallize at low
temperatures. • Crystals can be dissolved by placing intact
container in a warm water bath and warming to room
temperature.
Adverse Effects (≥1%): Body as a Whole: Most secondary to
ammonia toxicity. CNS: Headache, depression, drowsiness, twitching,
excitability; EEG abnormalities. CV: Bradycardia and other
arrhythmias. GI: Gastric irritation, nausea, vomiting, anorexia.
Metabolic: Metabolic acidosis, hyperammonia. Respiratory:
Hyperventilation. Skin: Rash. Urogenital: Glycosuria. Other: Pain
and irritation at IV site.
Diagnostic Test Interference: Ammonium chloride may increase
blood ammonia and AST, decrease serum magnesium (by
increasing urinary magnesium excretion), and decrease urine
urobilinogen.
Interactions: Drug: Aminosalicylic acid may cause crystalluria;
increases urinary excretion of AMPHETAMINES, flecainide, mexiletine,
methadone, ephedrine, pseudo-ephedrine; decreased urinary
excretion of SULFONYLUREAS, SALICYLATES.
Pharmacokinetics: Absorption: Completely absorbed in 3–6 h.
Metabolism: In liver to HCl and urea. Elimination: Primarily in urine.
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Ammonium Chloride. In Pearson Nurse's
2 Drug Guide 2012 (pp. 80–81). Upper Saddle River, NJ: Prentice Hall.
Nursing Implications
Assessment & Drug Effects
• Assess IV infusion site frequently for signs of irritation. Change
site as warranted.
• Monitor for S&S of: Metabolic acidosis (mental status changes
including confusion, disorientation, coma, respiratory changes
including increased respiratory rate and depth, exertional
dyspnea); ammonium toxicity (cardiac arrhythmias including
bradycardia, irregular respirations, twitching, seizures).
• Monitor I&O ratio and pattern. The diuretic effect of ammonium
chloride is compensatory and lasts only 1–2 days.
• Lab tests: Baseline and periodic determinations of CO2
combining power, serum electrolytes, and urinary and arterial pH
during therapy to avoid serious acidosis.
Patient & Family Education
• Report pain at IV injection site.
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Ammonium Chloride. In Pearson Nurse's
Drug Guide 2012 (pp. 80–81). Upper Saddle River, NJ: Prentice Hall. 3
