• Ammonium chloride, administered by mouth in doses of 4 to 6 gm. per day, is valuable in preventing hypochloremic alkalosis and improving the diuretic response to mercurials. In four cases here described, however, it caused lethargy, air hunger, and other severe symptoms of intoxication.
Three of the patients had long histories of heart disease. The fourth had a chronic infection of the urinary tract. In each there was reason to believe either that the liver failed to metabolize ammonium compounds normally or that the kidneys failed to excrete the products. In addition, ammonium chloride in sufficient dosage is capable of producing acidosis in normal subjects.
The acidosis can be combated with suitable alkalies such as sodium lactate, but the hepatic coma is not influenced by any specific therapy. It is therefore necessary to determine a patient's renal and hepatic status before instituting ammonium chloride therapy.
Sievers ML, Vander JB. TOXIC EFFECTS OF AMMONIUM CHLORIDE IN CARDIAC, RENAL AND HEPATIC DISEASE. JAMA. 1956;161(5):410–415. doi:10.1001/jama.1956.02970050012003
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