Medically reviewed by Drugs.com. Last updated on Jul 2, 2019.
(troe METH a meen)
- Tris Buffer
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tham: 30 mEq/100 mL (500 mL [DSC])
Brand Names: U.S.
- Tham [DSC]
- Alkalinizing Agent, Parenteral
Acts as a proton acceptor, which combines with hydrogen ions, liberating bicarbonate buffer, to correct acidosis. It buffers both metabolic and respiratory acids, limiting carbon dioxide generation. Also an osmotic diuretic.
30% of dose is not ionized
Distributes quickly into extracellular space; at steady state distributes into a volume slightly greater than total body water; penetrates slowly intracellularly
Urine (>75%) within 8 hours
Use: Labeled Indications
Correction of metabolic acidosis associated with cardiac bypass surgery or cardiac arrest; to correct excess acidity of stored blood that is preserved with acid citrate dextrose (ACD); indicated in infants needing alkalinization after receiving maximum sodium bicarbonate (8-10 mEq/kg/24 hours)
Hypersensitivity to tromethamine or any component of the formulation; uremia or anuria; chronic respiratory acidosis (neonates); salicylate intoxication (neonates)
Note: Tham solution is no longer available in the US.
Dose depends on buffer base deficit; when deficit is known: tromethamine (mL of 0.3 molar [M] solution) = body weight (kg) x base deficit (mEq/L) x 1.1
Metabolic acidosis with cardiac arrest:
IV: 3.6 to 10.8 g (111 to 333 mL of 0.3 M solution); additional amounts may be required to control acidosis after arrest reversed
Open chest: Intraventricular: 2 to 6 g (62 to 185 mL of 0.3 M solution). Note: Do not inject into cardiac muscle
Acidosis associated with cardiac bypass surgery: IV: Average dose: 9 mL/kg of 0.3 M solution (2.7 mEq/kg); 500 mL is adequate for most adults; maximum dose: 500 mg/kg over at least 1 hour
Excess acidity of acid citrate dextrose (ACD) blood in cardiac bypass surgery: 15 to 77 mL of 0.3 M solution added to each 500 mL of ACD blood
Refer to adult dosing.
Note: Tham solution is no longer available in the US. Dose dependent upon severity and progression of acidosis; doses should be administered slowly to prevent overtreatment. Tromethamine is available as a 0.3 M solution (THAM); doses are based on this concentration and expressed as volumes (mL/kg). Each mL of THAM = 0.3 mmol = 36 mg = 0.3 mEq
Metabolic acidosis: Infants, Children, and Adolescents: IV: Empiric dosage based upon base deficit: Dose (mL) of THAM = body weight (kg) x base deficit (mEq/L) x 1.1*
Usual range: 1 to 2 mEq/kg/dose; maximum dose in 24 hours: 15 mEq/kg/24 hours (15 mmol/kg/24 hours) (Kliegman 2007; Nahas 1998)
*Factor of 1.1 accounts for an approximate reduction of 10% in buffering capacity due to the presence of sufficient acetic acid to lower the pH of the 0.3 M solution to approximately 8.6
Metabolic acidosis with cardiac arrest: Limited data available: Note: Routine use of buffering agents during cardiac arrest not recommended (AHA [Klienman 2010]): Infants, Children, and Adolescents: THAM: IV: 1 mL/kg should raise bicarbonate concentration by 1 mEq/L (Fuhrman 2011)
IV: Correction of metabolic acidosis in cardiac bypass surgery: Administer by slow IV infusion over at least 1 hour (maximum rate: 500 mg/kg over at least 1 hour); rapid administration may result in prolonged hypoglycemia.
Correction of ACD blood acidity in cardiac bypass surgery: Add to each 500 mL of ACD blood used to prime the pump-oxygenator.
Correction of metabolic acidosis in cardiac arrest: If chest is open, instill directly into ventricular cavity; do NOT inject into cardiac muscle. If chest is not open, inject into a large peripheral vein.
Vesicant (with IV administration); ensure proper needle or catheter placement prior to and during administration; avoid extravasation.
Extravasation management: If extravasation occurs, stop IV administration immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity.
Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy
Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Monitor therapy
Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Consider therapy modification
Flecainide: Tromethamine may increase the serum concentration of Flecainide. Monitor therapy
Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Monitor therapy
Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Monitor therapy
QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Monitor therapy
Frequency not defined.
Cardiovascular: Localized phlebitis, venospasm
Endocrine & metabolic: Hyperkalemia, hypervolemia, hypoglycemia (usually doses >500 mg/kg administered over <1 hour)
Hepatic: Hepatic necrosis (resulted during delivery via umbilical venous catheter)
Local: Local irritation
Respiratory: Apnea, pulmonary edema, respiratory depression
Concerns related to adverse effects:
• Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during administration; avoid extravasation. May cause tissue inflammation and necrosis.
• Hypoglycemia: May cause hypoglycemia with extremely large doses.
• Respiratory depression: May cause respiratory depression; monitor closely especially if patient not intubated.
• Renal impairment: Use with caution in patients with renal impairment; reduce dose and monitor pH carefully.
• Duration of therapy: Drug should not be given for a period of longer than 24 hours unless for a life-threatening situation.
Serum electrolytes (especially potassium, blood glucose); renal function, arterial blood gases, ECG monitoring, fluid status, ventilation rate
Check infusion site frequently during administration.
Pregnancy Risk Factor
Animal studies have not been conducted.
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