Usage
- Ammonium chloride is prescribed for the treatment of metabolic alkalosis (a condition characterized by elevated blood pH) and hypochloremia (low chloride levels in the blood). It can also be used as an expectorant to thin and loosen mucus in the airways. Additionally, it is sometimes used to acidify urine, which can help prevent certain types of kidney stones or increase the effectiveness of some medications.
- Pharmacological Classifications: Systemic acidifying agent, urinary acidifying agent, expectorant.
- Mechanism of Action: Ammonium chloride is metabolized in the liver to urea and HCl, which leads to an increase in free hydrogen ions. These hydrogen ions react with bicarbonate, decreasing bicarbonate levels and lowering blood pH, thereby correcting alkalosis. The chloride ions help restore chloride balance in hypochloremia. As an expectorant, it acts by irritating the respiratory mucosa, stimulating mucus production and making it easier to cough up.
Alternate Names
- Sal ammoniac, Ammon Chloride.
- Brand names vary depending on the region and manufacturer.
How It Works
- Pharmacodynamics: Ammonium chloride acidifies the blood and urine. As an expectorant, it increases respiratory tract fluid, thins mucus, and promotes expectoration.
- Pharmacokinetics: Administered intravenously or orally. Orally administered ammonium chloride is absorbed readily from the GI tract within 5-6 hours of ingestion. The ammonium ion is metabolized in the liver to urea with resulting liberation of hydrogen ions and chloride ions into the extracellular fluid. These hydrogen ions react with bicarbonate, and the chloride ions increase chloride levels. Excreted by the kidneys.
- Mode of Action:
- In metabolic alkalosis, the metabolism of ammonium ions to urea releases hydrogen ions, which lower blood pH.
- The increased chloride concentration directly addresses hypochloremia.
- As an expectorant, it irritates the bronchial mucosa, promoting secretions and thinning mucus.
- Elimination Pathways: Primarily renal excretion.
Dosage
Standard Dosage
Adults:
- Oral: As an expectorant, 300-600 mg every 2-4 hours. For metabolic alkalosis, the dose is variable and depends on the severity of the condition and the patient’s clinical status, refer to local guidelines.
- Intravenous: 100-200 mEq diluted in 500-1000 mL of 0.9% NaCl. Infuse at a rate not exceeding 5 mL/minute.
Children:
- Dosage should be individualized based on the child’s weight and the condition being treated. Refer to local treatment protocol and guidelines.
Special Cases:
- Elderly Patients: Use with caution due to potential for decreased renal and hepatic function. Adjust dose as needed based on patient’s clinical condition.
- Patients with Renal Impairment: Contraindicated in severe renal impairment. Use with caution in mild to moderate renal impairment, adjusting the dose as per renal function.
- Patients with Hepatic Dysfunction: Contraindicated in severe hepatic dysfunction. Use cautiously in patients with mild-to-moderate hepatic impairment.
- Patients with Comorbid Conditions: Monitor closely and adjust dosage as needed based on clinical conditions such as cardiac, pulmonary, or other metabolic disorders.
Clinical Use Cases
- Specific dosage guidelines for clinical use cases like intubation, surgical procedures, mechanical ventilation, and ICU use are not found in the provided resources. Please refer to local guidelines and protocols.
Dosage Adjustments
- Dose adjustments may be required based on patient-specific factors such as renal/hepatic function, coexisting medical conditions, and clinical response. Serum bicarbonate levels should be monitored during intravenous administration.
Side Effects
Common Side Effects
- Oral administration: Nausea, vomiting, stomach irritation.
- Intravenous administration: Pain or irritation at the injection site.
Rare but Serious Side Effects
- Ammonia toxicity (pallor, sweating, irregular breathing, bradycardia, cardiac arrhythmias, twitching, convulsions, coma), metabolic acidosis.
Long-Term Effects
- Potential for calcium oxalate urinary stone formation with prolonged use, especially in cats.
Adverse Drug Reactions (ADR)
- Ammonia toxicity, severe metabolic acidosis, hyperkalemia.
Contraindications
- Severe renal or hepatic impairment, primary respiratory acidosis, patients with high total CO2 and buffer base secondary to primary respiratory acidosis, hyperkalemia.
Drug Interactions
- Potassium-sparing diuretics may increase the risk of hyperkalemia.
- May decrease the serum concentration of amphetamines, lisdexamfetamine, methamphetamine, methylenedioxymethamphetamine, and pseudoephedrine, amongst others.
- Alkalis and carbonates are chemically incompatible with ammonium chloride.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C. Animal reproduction studies have not been conducted with ammonium chloride. It is also not known whether ammonium chloride can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Ammonium chloride should be given to a pregnant woman only if clearly needed.
- It is not known if this drug is excreted in human milk. Use with caution in lactating women.
Drug Profile Summary
- Mechanism of Action: Increases systemic and urinary acidity through the metabolism of ammonium to urea, releasing hydrogen ions.
- Side Effects: Nausea, vomiting, stomach irritation (oral), injection site pain (IV), ammonia toxicity, metabolic acidosis.
- Contraindications: Severe renal/hepatic impairment, primary respiratory acidosis.
- Drug Interactions: Potassium-sparing diuretics, agents that alkalinize urine, certain medications metabolised in the liver.
- Pregnancy & Breastfeeding: Category C; use with caution if clearly needed.
- Dosage: Variable, depending on the route of administration and indication. Refer to detailed dosage section.
- Monitoring Parameters: Serum bicarbonate, blood pH, electrolytes, ammonia levels (if toxicity is suspected).
Popular Combinations
- Not applicable as there are no popular combinations described within provided sources.
Precautions
- General Precautions: Monitor renal and hepatic function, electrolyte levels, acid-base balance.
- Specific Populations: Use cautiously in pregnant/breastfeeding women, children, and the elderly.
- Lifestyle Considerations: No specific lifestyle considerations mentioned in the provided resources.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride?
A: The dosage varies depending on the patient’s age, weight, route of administration and the condition being treated. Refer to the detailed dosage section above.
Q2: How does ammonium chloride work as an expectorant?
A: It irritates the respiratory mucosa, stimulating mucus production and thinning existing mucus, thus facilitating expectoration.
Q3: What are the serious side effects of ammonium chloride?
A: Serious side effects include ammonia toxicity and metabolic acidosis.
Q4: Who should not take ammonium chloride?
A: Patients with severe renal or hepatic impairment, primary respiratory acidosis or patients with high total CO2 and buffer base secondary to primary respiratory acidosis.
Q5: Can ammonium chloride be used during pregnancy?
A: Pregnancy Safety Category C. Only use if clearly needed and if the potential benefits outweigh the risks.
Q6: How is ammonium chloride administered?
A: Can be administered intravenously (after appropriate dilution) or orally.
Q7: What are the signs of ammonium chloride toxicity?
A: Pallor, sweating, irregular breathing, bradycardia, cardiac arrhythmias, twitching, convulsions, and coma.
Q8: Does ammonium chloride interact with any medications?
A: Yes, it can interact with potassium-sparing diuretics, agents that alkalinize urine, as well as drugs that are cleared by the liver and kidneys.
Q9: What should be monitored in patients taking ammonium chloride?
A: Serum bicarbonate, electrolytes, renal and hepatic function, and ammonia levels if toxicity is suspected.
Q10: How should ammonium chloride be administered intravenously?
A: It must be diluted in 0.9% NaCl to a concentration not exceeding 1-2% and infused slowly. Monitor serum bicarbonate levels.
