Neonatal Drug Therapy Manual

Arginine hydrochloride

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

Updated March 5, 2024 - 2:32pm

Alternate Name(s): 
Arginine HCL
Classification: 
Hyperammonemia agent
Original Date: 
Sept 2022
Indications: 
  • Hyperammonemia, acute (urea cycle disorders)
Administration: 
  • IV Intermittent Infusion. Give IV over 90 minutes. Central line preferred
  • IV Continuous Infusion. Maximum Infusion rate: 1 g/kg/hr. Central line preferred
Dosage: 

Urea Cycle Disorders: 

Argininosuccinate synthetase (ASS, Citrullinemia) or Argininosuccinate lyase (ASL) deficiency:

  •  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

Carbamyl phosphate synthetase (CPS), ornithine transcarbamylase (OTC)  deficiency:

  • 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
Side Effects: 
  • 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.
Parameters to Monitor: 
  • Monitor acid-base status (arterial or capillary blood gases), serum electrolytes, BUN, glucose, ammonia every 4 hours in the acute phase
Reconstitution and Stability: 

CHEO

  • Available from pharmacy, most often as a combo product with Ammonul®* (Sodium Phenylacetate and Sodium Benzoate).
    • Often prepared as Ammonul® 10 mg/mL with Arginine HCL 24 mg/mL in D10W

*see monograph for Ammonul®

Compatibility: 
  • Solutions Compatible:  NS, D10W
  • Additives/Above Cassette Compatible: Ammonul®, sodium bicarbonate
  • Y-site Compatible: Ammonul®, sodium bicarbonate
Notes: 
  • Arginine 250 mg/mL contains 0.475 mmol/mL of chloride

  •  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.

References: 
  • Lexi-Comp Online Database, accessed Sept 2022
  • Arginine HCL Injection Product Monograph

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