From the Guidelines
Ammonium chloride ingestion can result in superficial hemorrhagic gastritis, which may progress during the first 24-48 hours and requires specific surveillance. When considering the use of ammonium chloride, either intentionally or in the case of accidental ingestion, it's crucial to understand its potential effects on the body. In the context of corrosive injuries, strong acids and alkalis are responsible for most severe caustic injuries to the gastrointestinal tract, but ammonium chloride, being a compound that can release acidic conditions, poses its own set of risks 1. The physical form of the ingested substance, whether solid or liquid, and the quantity ingested are critical factors in determining the extent of damage to the gastrointestinal tract.
Key considerations in managing ammonium chloride ingestion include:
- Identifying the nature and quantity of the ingested agent
- Understanding the accidental or voluntary pattern of ingestion
- Recognizing the potential for systemic toxicity and the need to contact Poison Control Centers for evaluation (Grade 2B) 1
- Being aware of the specific surveillance required for superficial hemorrhagic gastritis that may progress over the first 24-48 hours after ingestion
Given the potential for severe systemic effects, including metabolic disturbances such as hypocalcemia, hyponatremia, hypokalemia, and acidosis, careful management and monitoring are essential in cases of ammonium chloride ingestion 1. The compound's use as an expectorant or urinary acidifier in medicine underscores the need for adherence to guidelines to avoid adverse health effects.
From the Research
Ammonium Chloride Uses
- Ammonium chloride can be used to treat metabolic alkalosis, as seen in a case series where enteral administration of injectable ammonium chloride was effective in treating persistent metabolic alkalosis in pediatric patients 2.
- It can be administered intravenously, and dosage guidelines have been described in the literature 3.
Ammonium Chloride Administration
- Enteral administration of ammonium chloride may offer an effective method for the treatment of persistent metabolic alkalosis without the adverse effects associated with the intravenous route 2.
- Intravenous administration of ammonium chloride or dilute hydrochloric acid can be used to treat severe metabolic alkalosis, especially when rapid resolution is needed or conventional therapy cannot be tolerated 3.
Risks and Complications
- Ammonium chloride can cause adverse effects, such as coma, in patients with normal hepatic and renal function 4.
- Intentional ingestion of dilute ammonium chloride solutions can cause serious injury to the gastrointestinal tract and pulmonary systems, leading to a complicated and prolonged hospitalization 5.
Metabolic Alkalosis Treatment
- Metabolic alkalosis can be treated with fluid and electrolyte therapy, and mineral acid administration may be necessary in some cases 3, 6.
- The primary drug of choice for treating metabolic alkalosis is intravenous ammonium chloride, but patients with hepatic or severe renal dysfunction may require alternative therapy, such as dilute hydrochloric acid 3.