Parenteral Manual

Arginine hydrochloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Classification: 
Diagnostic agent, Hyperammonemia agent
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Pituitary function test (growth hormone)
  • Severe metabolic alkalosis (pH >7.55)
  • Treatment of hyperammonemia due to urea cycle enzyme deficiency
Reconstitution and Stability: 
  • Available as vials of 250 mg/mL solution
  • Vial stable 24 hrs at room temperature once punctured
  • Solutions with sodium bicarbonate are stable 24 hours at room temperature
  • Solutions with D10W and/or Ammonul® stable 24 hours
Compatibility: 

- Solutions Compatible:  NS, D10W

- Additives/Above Cassette Compatible: Ammonul®, sodium bicarbonate

- Y-site Compatible: Ammonul®, sodium bicarbonate

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion YES
Usual dilution: 25 - 125 mg/mL
Infusion time: see dosage guidelines, depends on indication
Maximum Infusion rate: 1 g/kg/hr up to 60 g/hr
IV Continuous Infusion YES
Usual dilution: 25 - 125 mg/mL
Maximum Infusion rate: 1 g/kg/hr up to 60 g/hr
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Growth hormone test: 

  • 500 mg/kg IV over 30 minutes (Maximum: 30 g) or 4 mL/kg of a 12.5% solution IV over 30 minutes (Maximum: 240 mL)

Urea Cycle Disorders: 

ASL or ASS:

  •  Loading: 600 mg/kg IV as a loading dose. Give IV over 90 minutes
  •  Maintenance: Followed by 600 mg/kg/day as a continuous IV infusion

CPS or OTC:

  • Loading: 200 mg/kg IV as a loading dose. Give IV over 90 minutes
  • Maintenance: Followed by 200 mg/kg/day as a continuous IV infusion
Potential hazards of parenteral administration: 
  • IV infiltration may cause necrosis and phlebitis
  • Flushing, headache, nausea and vomiting with rapid infusion
  • Hyperglycemia, metabolic acidosis, hyperchloremia
  • Potassium levels: more commonly hyperkalemia is experienced, however, hypokalemia is possible in some (follow levels closely)
  • Arginine may result in overproduction of nitric oxide, which may result in hypotension and vasodilation.
Notes: 
  • Monitor acid-base status (arterial or capillary blood gases), serum electrolytes, BUN, glucose, ammonia every 4 hours in the acute phase
  • Arginine 250 mg/mL contains 0.475 mmol/mL of chloride
  • Available in metabolic kit in resus room in emergency
References: 

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