Pharm

Tromethamine

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Tromethamine, THAM

  • Indications
  1. Severe Metabolic Acidosis from Cardiac Arrest (alternative to Sodium Bicarbonate)
  • Mechanism
  1. Weak base binds Hydrogen Ions and excreted renally
  • Effects
  1. Unlike Sodium Bicarbonate which relies on CO2 exhalation to correct Metabolic Acidosis, THAM is renally excreted
    1. THAM may be preferred over Sodium Bicarbonate in the non-ventilated patient with Respiratory Acidosis
  2. Unlike Sodium Bicarbonate which lowers Serum Potassium, THAM does not alter Potassium levels
  3. Unlike Sodium Bicarbonate which increases Serum Sodium, THAM lowers Serum Sodium
  • Dosing
  1. Dose = wtKg x baseDeficit x 1.1
  • Precautions
  1. Avoid acidosis over-correction
  • Efficacy
  1. As with Sodium Bicarbonate, no evidence of outcome benefit in correction of Metabolic Acidosis
  • Adverse effects
  1. Slowed Respiratory Rate
  2. Hypoglycemia
  • References
  1. Lin and Geier in Herbert (2016) EM:Rap 16(1):14-5
  2. Hoste (2005) J Nephrol 18(3): 303-7 +PMID:16013019 [PubMed]