Monograph: |
Ammonium Citrate
Adverse Effects and Treatment
Ammonium salts are irritant to the gastric mucosa and may
produce nausea and vomiting particularly in large doses.
Large doses of ammonium chloride may cause a profound ac-
idosis and hypokalaemia which should be treated symptomat-
ically. Intravenous administration of ammonium chloride
may cause pain and irritation at the site of injection, which
may be decreased by slowing the rate of infusion.
Excessive doses of ammonium salts, particularly if adminis-
tered by rapid intravenous injection, may give rise to hepatic
encephalopathy due to the inability of the liver to convert the
increased load of ammonium ions to urea.
Precautions
Ammonium salts are contra-indicated in the presence of im-
paired hepatic or renal function.
Pharmacokinetics
Ammonium chloride/citrate is absorbed from the gastro-intestinal
tract. The ammonium ion is converted into urea in the liver,
the anion thus liberated into the blood stream and extracellu-
lar fluid causes a metabolic acidosis and decreases the pH of
the urine; this is followed by transient diuresis.
Uses and Administration
Ammonium chloride/citrate is used as an expectorant in productive
cough. Other ammonium salts which have been used
similarly include the acetate, bicarbonate, camphorate, car-
bonate, citrate, and glycynhizmate.
The administration of ammoniam citrate produces a tran-
sient diuresis and a mild acidosis. It may be used in the treat-
ment of severe metabolic alkalosis.
Ammonium chloride/citrate may also be used to maintain the urine
at an acid pH in the treatment of some urinary-tract disorders.
or in forced acid diuresis procedures to aid the excretion of
basic drugs, such as amphetamines, in severe cases of over-
dosage. It is usually given by mouth, often as enteric-coated
tablets, in a dose of 1 to 2 g every four to six hours, although
4 g every two hours has been given in forced acid diuresis
procedures.
Ammonium chloride/citrate has been promoted for self administra-
tion as a diuretic, for example in premenstrual water reten-
tion: a dose of 1 g three times daily for up to 6 days has been
suggested, but such use is generally considered inappropriate.
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