Tromethamine Dosage

Applies to the following strengths: 3.6 g/100 mL

Usual Adult Dose for Metabolic Acidosis

Associated with Cardiac Bypass Surgery:
Initial dose: 500 mL (150 mEq) by slow intravenous infusion is considered adequate for most adults; up to 1000 mL may be required in severe cases
Maximum dose: 500 mg/kg (227 mg/lb) over a period of not less than one hour

Associated with Cardiac Arrest:
If the chest is open: 2 to 6 g (62 to 185 mL of a 0.3 M solution) injected into the ventricular cavity
If the chest is not open: 3.6 to 10.8 g (111 to 333 mL of a 0.3 M solution) injected into a larger peripheral vein if the chest is not open
Comment: Do not inject into the cardiac muscle

Usual Pediatric Dose for Metabolic Acidosis

Associated with RDS in Neonates and Infants:
1 mL/kg for each pH unit below 7.4

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage should be limited to an amount sufficient to increase blood pH to normal limits (7.35 to 7.45) and to correct acid-base derangements

Estimate the IV dosage of tromethamine injection from the buffer base deficit of the extracellular fluid in mEq/liter determined by means of the Siggaard-Andersen nomogram.

Use the following formula as a general guide:
Tromethamine solution (mL of 0.3 M) required =
Body Weight (kg) X
Base Deficit (mEq/liter) X 1.1

Note: Factor of 1.1 accounts for an approximate reduction of 10% in buffering capacity due to the presence of sufficient acetic acid to lower pH of the 0.3 M solution to approximately 8.6

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:

Administer by slow intravenous infusion by addition to pump-oxygenator ACD blood or other priming fluid or by injection into the ventricular cavity during cardiac arrest
Use a large needle in the largest antecubital vein or an indwelling catheter placed in a large vein of a limb for infusion in a peripheral vein
Catheters are recommended

Storage requirements: Protect from freezing

Reconstitution/preparation techniques:

Do not administer unless solution is clear and the seal is intact
Discard unused portion

IV compatibility:

Additives may be incompatible
When introducing additives, use aseptic technique, mix thoroughly and do not store

Monitoring: Pretreatment and subsequent determinations of blood values (pH, PCO2, PO2, glucose and electrolytes) and urinary output should be made as necessary to monitor dosage and the progress of treatment.