Ammonium chloride salts are occasionally injected directly into the bloodstream

Question

Ammonium chloride salts are occasionally injected directly into the bloodstream of patients with severe hypochloremia as a means to rapidly raise the chloride concentration in extracellular fluids without also raising extracellular sodium concentrations. However, when an isotonic ammonium chloride solution (osmolarity = 289 mOsm/L) is injected into human blood, the cells will undergo hemolysis because ammonium ions rapidly enter erythrocytes. What is the most reasonable solution to this problem?

Explanation / Answer

Hypochloremia is a condition when serum chloride level is lesser than 96 m Eq/L. Normal chloride level in serum is 101 to 112 m Eq/L. Normal serum osmolarity is 280 to 295 m Osm/ L. Ammonium Chloride salts are used for hypochloremia, and act as acidifying agent in vivo, as reacts to release hydrogen ions, and are more effective under metabolic alkalosis. The doses applied should be calculated as per patient’s serum chloride level and body weight. The hemolytic effect of isotonic Ammonium chloride solution is also related to the fragility of the erythrocytes and colloid osmotic lysis. The process of lysis occurs with isotonic Ammonium chloride as: Initially ammonium ions diffuses through cell membrane and there is increase in HCO3. The chloride of ammonium chloride is exchanged through Cl-/HCO3- trans-membrane anion exchanger of erythrocytes. This results in excess influx of ammonium chloride in RBC, causing lysis. An alternative option to prevent it is the use of a neutrally composed buffer, like using sodium dodecyl sulphate and albumin, that stabilizes RBC membrane and excess ammonium influx, to prevent hemolysis.

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