氯化銨
**氯化銨**是一種全身性及尿液酸化劑。 * **主要用途：** 預防和溶解特定類型的尿結石（如磷酸銨鎂結石），促進特定毒素（如鍶、番木鱉鹼）或藥物（如奎尼丁）的腎臟排泄，並提高某些抗菌藥物在泌尿道中的療效。 * **代謝性鹼中毒：** 可透過靜脈注射快速糾正嚴重的代謝性鹼中毒。 * **臨床要點：** 由於高效能的磷酸銨鎂溶解處方飼料（本身會引起酸性尿）的普及，目前已很少建議貓咪使用氯化銨來控制結石。但它仍是小型反芻動物預防尿結石的常用藥物，儘管飲食中的粗飼料與精飼料比例會顯著影響其療效。
作用機制: Ammonium chloride induces acidification through hepatic metabolism: * **Dissociation:** In vivo, it dissociates into **chloride** and **ammonium** ions. * **Hepatic Conversion:** The liver converts the ammonium cation to urea, releasing a **hydrogen ion (H⁺)**. * **Acidification Pathway:** H⁺ combines with bicarbonate → H₂O + CO₂. This depletes extracellular alkaline reserves, decreasing serum bicarbonate and lowering both blood and urine pH. * **Renal Excretion:** Excess chloride ions exceed tubular reabsorption capacity and are excreted alongside cations (mainly sodium) and water, causing a mild, transient **diuretic effect**.
各物種劑量
- Urolithiasis prevention · 300 mg/kg PO · PO · Unknown
- Urolithiasis prevention · 0.5-1% of the daily dry matter · PO · Daily · Table sugar may improve palatability
- Urolithiasis prevention · 300 mg/kg PO · PO · Unknown
- Urolithiasis prevention · 0.5-1% of the daily dry matter · PO · Daily · Table sugar may improve palatability
- Struvite dissolution therapy if diet and antimicrobials do not result in acid urine or to help prevent idiopathic FUS in a non-obstructed cat · 20 mg/kg PO twice daily · PO · q12h
- Adjunctive therapy for struvite uroliths · 20 mg/kg PO twice daily · PO · q12h
- Urolithiasis prevention · 200 mg/kg PO · PO · Unknown
- Urolithiasis prevention · 15-30 grams PO · PO · Unknown
- General dosing · 4-15 grams PO · PO · Unknown
- Urinary acidifier · 60-520 mg/kg PO daily · PO · q24h · Unpalatable; dose via stomach tube or dosing syringe
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Severe hepatic disease
- Uremia
- Urate calculi
- Respiratory acidosis
- Severe renal insufficiency with metabolic alkalosis secondary to vomiting
不良反應
- Metabolic acidosis
- Gastric irritation
- Nausea
- Vomiting
- Pain at injection site (IV)
- Increased risk of calcium oxalate urolith formation (cats)
藥物相互作用
- Aminoglycosides · Urine acidification may diminish effectiveness in treating bacterial urinary tract infections
- Erythromycin · Urine acidification may diminish effectiveness in treating bacterial urinary tract infections
- Quinidine · Urine acidification may increase renal excretion
監測
- Urine pH (goal is ≤6.5)
- Blood pH (if clinical signs of toxicity or treating metabolic alkalosis)
- Serum electrolytes (with chronic use or treating metabolic acidosis)
- Carbon dioxide combining power of serum (prior to IV use to prevent serious acidosis)
過量
**Clinical Signs:** Nausea, vomiting, excessive thirst, hyperventilation, bradycardia or other arrhythmias, and progressive CNS depression. Laboratory results may show profound acidosis and hypokalemia. **Treatment:** * Correct acidosis by administering sodium bicarbonate or sodium acetate intravenously. * Treat hypokalemia using a suitable oral (if possible) potassium product. * Perform intense, ongoing acid-base and electrolyte monitoring until the patient is stable.
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。