AMMONIUM CHLORIDE 2.14%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for AMMONIUM CHLORIDE 2.14% (AMMONIUM CHLORIDE 2.14%).
Ammonium chloride is an acidifying agent. It dissociates into ammonium and chloride ions. The ammonium ion is metabolized in the liver to urea and hydrogen ions, leading to metabolic acidosis. This reduces blood pH and increases renal excretion of alkaline urine.
| Metabolism | Converted to urea and hydrogen ions in the liver via the urea cycle. |
| Excretion | Renal: >99% as ammonium ion and chloride; minimal biliary/fecal elimination. |
| Half-life | 4-6 hours; prolonged in renal impairment (up to 12-15 hours). |
| Protein binding | Negligible (<1%); not significantly bound to plasma proteins. |
| Volume of Distribution | 0.3-0.5 L/kg; distributes primarily in extracellular fluid; clinical meaning: low Vd reflects limited tissue penetration. |
| Bioavailability | Oral: 100% (fully absorbed); IV: 100%; topical: non-systemic. |
| Onset of Action | Oral: 30-60 minutes for diuretic effect; IV: 15-30 minutes for metabolic acidosis correction. |
| Duration of Action | Oral: 4-6 hours; IV: 2-4 hours; effects persist while acid-base balance is maintained. |
For metabolic alkalosis: 1.5 to 3 g (approximately 280 to 560 mEq) intravenously over 4 to 6 hours; adjust based on serum chloride and pH.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <30 mL/min). For GFR 30-60 mL/min: reduce dose by 50% and monitor serum electrolytes. For GFR >60 mL/min: no adjustment. |
| Liver impairment | No specific Child-Pugh based adjustment; use caution in severe hepatic impairment due to risk of ammonia toxicity. |
| Pediatric use | Neonates and children: 1-2 mEq/kg intravenously per dose, infused over 2-4 hours; maximum 100 mEq per dose. Titrate based on serum chloride and acid-base status. |
| Geriatric use | Start at lower end of adult dosing (e.g., 1.5 g intravenously) due to age-related decreased renal function; monitor electrolytes and renal function closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for AMMONIUM CHLORIDE 2.14% (AMMONIUM CHLORIDE 2.14%).
| Breastfeeding | Excretion into breast milk is unknown. M/P ratio not available. Caution advised due to potential for neonatal acidosis if maternal doses are high. Short-term use is likely compatible with breastfeeding. |
| Teratogenic Risk | Ammonium chloride is not known to be teratogenic in humans. No structural anomalies have been reported with first trimester exposure. In second and third trimesters, maternal acidosis from excessive dosing could potentially affect fetal acid-base balance, but no specific fetal risks are documented. Overall, classified as FDA Pregnancy Category C. |
■ FDA Black Box Warning
None
| Serious Effects |
["Severe hepatic insufficiency","Severe renal impairment","Hyperammonemia","Uremia","Ammonium toxicity"]
| Precautions | ["Avoid in patients with impaired renal or hepatic function; may cause hyperammonemia and hepatic coma.","Use with caution in patients with cardiac failure or pulmonary edema due to risk of fluid overload.","Monitor serum chloride, bicarbonate, and pH levels during therapy."] |
| Food/Dietary | No significant food interactions known. However, a diet low in chloride may reduce efficacy. Avoid excessive intake of alkalinizing foods (e.g., citrus fruits, vegetables) that may counteract the acidifying effect. |
Loading safety data…
| Fetal Monitoring | Monitor maternal serum electrolytes (chloride, bicarbonate), blood pH, urine pH, and renal function. In pregnancy, watch for signs of metabolic acidosis (hyperventilation, confusion). Fetal monitoring is not required unless maternal acidosis develops. |
| Fertility Effects | No known effects on human fertility. Animal studies not reported. Unlikely to impact reproductive function at therapeutic doses. |
| Clinical Pearls |
| Ammonium chloride 2.14% is a systemic acidifying agent used to treat metabolic alkalosis. Monitor serum electrolytes (especially chloride and bicarbonate) and arterial blood gases closely. Avoid in patients with severe hepatic or renal impairment, as ammonium ions can precipitate hepatic encephalopathy or worsen acidosis. Infuse slowly to prevent hemolysis. Use with caution in patients with respiratory acidosis. |
| Patient Advice | This medication is used to treat low acid levels in the blood. · Your healthcare provider will monitor your blood tests regularly while on this medicine. · Report any signs of allergic reaction (rash, itching, swelling) or symptoms of acidosis (confusion, rapid breathing) immediately. · Avoid taking other medications or supplements without consulting your doctor, as they may interfere with this treatment. · Do not stop this medication abruptly without medical advice. |