AMMONIUM CHLORIDE IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for AMMONIUM CHLORIDE IN PLASTIC CONTAINER (AMMONIUM CHLORIDE IN PLASTIC CONTAINER).
Ammonium chloride is an acidifying agent that provides chloride ions and ammonium ions. The ammonium ion is converted to urea in the liver, releasing hydrogen ions, which leads to metabolic acidosis. It also directly stimulates the respiratory center and promotes diuresis by increasing the osmotic load.
| Metabolism | Metabolized primarily in the liver via the urea cycle; ammonium ion is converted to urea, releasing hydrogen ions. The chloride ion is excreted renally. |
| Excretion | Renal: >99% as ammonium and chloride ions. The kidney converts ammonia to urea, which is excreted in urine. Fecal and biliary elimination are negligible. |
| Half-life | Terminal elimination half-life is approximately 2-4 hours in adults with normal hepatic and renal function. This reflects the rapid conversion of ammonium to urea in the liver and subsequent renal clearance. Half-life may be prolonged in hepatic or renal impairment. |
| Protein binding | <1% bound to plasma proteins. Ammonium ions are primarily free in plasma. |
| Volume of Distribution | Approximately 0.2-0.3 L/kg, reflecting distribution mainly in extracellular fluid. Ammonium ions do not significantly penetrate cells under normal conditions. |
| Bioavailability | Oral: ~100% absorbed from the gastrointestinal tract, though first-pass hepatic metabolism (urea cycle) limits systemic availability of intact ammonium. Intravenous: 100% bioavailable. |
| Onset of Action | Oral: Onset of metabolic effect (acidification) occurs within 1-3 hours. Intravenous: Onset within 15-30 minutes when administered as a slow infusion for metabolic alkalosis. |
| Duration of Action | Duration of acidifying effect is approximately 4-6 hours after oral administration, dependent on renal function and acid-base status. For intravenous use, the effect subsides within 2-3 hours after cessation of infusion due to rapid conversion to urea. |
| Molecular Weight | 53.49 |
For metabolic alkalosis: 1-2 g intravenously every 6-12 hours as needed; maximum 6 g/day. For hypochloremic states: 1-2 g orally or intravenously 2-3 times daily.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <30 mL/min). For GFR 30-50 mL/min: reduce dose by 50% and monitor serum chloride and ammonia. For GFR >50 mL/min: no adjustment necessary. |
| Liver impairment | Contraindicated in severe hepatic insufficiency (Child-Pugh class C). For Child-Pugh class B: use with caution, reduce dose by 50% and monitor ammonia levels. For Child-Pugh class A: no adjustment necessary. |
| Pediatric use | For metabolic alkalosis: 50-100 mg/kg intravenously every 6-8 hours; maximum 2 g/day. For hypochloremic states: 75 mg/kg/day orally in divided doses. |
| Geriatric use | Start at lower end of dosing range (e.g., 1 g intravenously every 12 hours) due to age-related decline in renal function; monitor serum electrolytes and renal function closely. |
| 1st trimester | Ammonium chloride is generally avoided during first trimester due to potential for metabolic acidosis and possible teratogenic effects in animal studies; use only if clearly needed. |
| 2nd trimester | May be used if needed, but caution due to risk of maternal acidosis which could affect fetal well-being. |
| 3rd trimester | Use with caution; maternal acidosis may cause fetal distress; avoid prolonged use. |
Clinical note
Comprehensive clinical and safety monograph for AMMONIUM CHLORIDE IN PLASTIC CONTAINER (AMMONIUM CHLORIDE IN PLASTIC CONTAINER).
| Placental transfer | Ammonium chloride crosses the placenta; the degree of transfer is likely extensive due to low molecular weight and water solubility. |
| Breastfeeding | Ammonium chloride is excreted into breast milk in small amounts. It is generally considered safe if used at therapeutic doses, but monitor infant for signs of acidosis. |
| Lactation Rating | L2 (Possibly Safe) |
| Teratogenic Risk | FDA Pregnancy Category C. Ammonium chloride crosses the placenta. First trimester: insufficient human data; animal studies not available; theoretical risk of fetal acidosis if maternal acidosis induced. Second/third trimester: may cause fetal acidosis, electrolyte disturbances, and potential for fetal harm if maternal overdose or pre-existing acidosis. |
| Fetal Monitoring | Monitor maternal serum electrolytes (sodium, chloride, bicarbonate, potassium), acid-base status (arterial pH, pCO2, bicarbonate), and ammonia levels. Assess fetal heart rate and growth if used long-term. |
| Fertility Effects | No human data on fertility. In animals, no reproductive studies reported. Theoretical potential for systemic acidosis to impair spermatogenesis or ovulatory function. |
■ FDA Black Box Warning
None
| Serious Effects |
Severe hepatic impairmentSevere renal impairmentMetabolic alkalosisHypersensitivity to ammonium chloride
| Precautions | Use with caution in patients with hepatic impairment (risk of ammonia toxicity), renal dysfunction, or respiratory acidosis. Monitor acid-base status, serum chloride, and ammonia levels. Avoid rapid infusion to prevent severe acidosis. Not for use in severe hepatic insufficiency. |
| Food/Dietary | Avoid excessive dietary intake of chloride-rich foods (e.g., table salt, processed foods) as it may affect treatment. No specific food restrictions, but maintain balanced diet as advised by physician. |
| Clinical Pearls | Ammonium chloride is used to treat severe metabolic alkalosis by providing chloride ions and generating mild metabolic acidosis. Monitor serum chloride, bicarbonate, and pH closely during infusion. Avoid in patients with severe hepatic impairment or renal failure. Infusion may cause local irritation; ensure proper IV access. |
| Patient Advice | This medication is used to correct an acid-base imbalance in your blood. · It will be given intravenously (IV) by a healthcare professional. · Report any burning, pain, or redness at the IV site immediately. · Do not consume large amounts of salt or salty foods unless directed. · Tell your doctor if you have liver or kidney disease. |
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