- Acute treatment of hyperammonemia associated with urea cycle disorders
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IV Intermittent Infusion: central line
Infusion time: 90 minutes -
IV Continuous Infusion: central line
- Loading: 250 mg/kg/dose IV as a loading dose. Give IV over 90 minutes
- Maintenance: Followed by 250 mg/kg/day as a continuous IV infusion
- IV infiltration may cause necrosis and phlebitis
- Nausea, vomiting (especially with loading dose)
- Hypotension
- Metabolic acidosis, hyperglycemia, hypokalemia, hypocalcemia, hyperammonemia, hypernatremia
- Seizure, cerebral edema, agitation
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Monitor plasma ammonia levels, neurological status, blood gases
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Electrolytes and glucose
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LFTs and renal function (use with caution in renal or hepatic impairment)
CHEO
- Available from pharmacy as a 10 mg/mL solution in D10W, with or without Arginine HCL* added.
*see monograph for Arginine HCL
- Solutions Compatible: D10W ONLY
- Additive/Above Cassette Compatible: arginine HCL, sodium bicarbonate
- Y-site Compatibility: arginine HCL, sodium bicarbonate
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For 250 mg/kg Ammonul® and 600 mg/kg Arginine HCL dosing, use Ammonul® 10 mg/mL with Arginine HCL 24 mg/mL in D10W.
- Fluid overload: Use with caution in patients at risk for fluid overload (eg, heart failure, severe renal impairment) or sodium retention edema; contains a significant amount of sodium (Ammonul® vials of 100 mg/mL contains 0.52 mmol of sodium/mL)
- Caution in neonates: displaces bilirubin from protein-binding site
- Enhanced potassium excretion may occur with treatment of hyperammonemia, monitor serum potassium concentration closely.
- Lexi-Comp Online Database, accessed Sept 2022
- Ammonul Product Monograph