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Tromethamine (Tham)
(troh- METH-ah-meen)
Pregnancy Category: C Tham Tham-E (Rx)

Classification: Systemic alkalizing and buffering agent

Action/Kinetics: Actively binds hydrogen ions, thereby decreasing and correcting acidosis. It promotes the excretion of acids, carbon dioxide, and electrolytes and is thought to be able to neutralize some intracellular acid. It acts as an osmotic diuretic, increasing urine flow. Seventy-five percent of the drug is eliminated within 8 hr, the remainder within 3 days.

Uses: Prevention and correction of systemic acidosis, especially that accompanying cardiac bypass surgery, correction of acidity of acid citrate dextrose (ACD) blood in cardiac bypass surgery, and cardiac arrest.

Contraindications: Uremia and anuria.

Special Concerns: Use with caution in newborns and infants and in clients with renal disorders.

Side Effects: Respiratory: Respiratory depression, especially in those with chronic hypoventilation or getting drugs that depress respiration. Other: Fever, hypervolemia, transient decrease of blood glucose. At injection site: Extravasation may cause inflammation, vascular spasms, and tissue damage (e.g., chemical phlebitis, thrombosis, necrosis, sloughing). In newborn: Hemorrhagic liver necrosis when given by umbilical vein.

Overdose Management: Symptoms: Alkalosis, overhydration, hypoglycemia (severe and prolonged), solute overload. Treatment: Discontinue the infusion and treat symptoms.

How Supplied: Injection: 3.6 g/100 mL

Minimum amount to correct acid-base imbalance. The amount of tromethamine can be estimated using the buffer base deficit of the extracellular fluid: mL of 0.3 M tromethamine solution required = body weight (kg) x base deficit (mEq/L) x 1.1
?Slow IV Infusion Acidosis in cardiac bypass surgery.
Adults: 500 mL (150 mEq or 18 g) as a single dose. Severe cases may require 1,000 mL. Do not exceed 500 mg/kg in a period less than 1 hr.
?Injection into Ventricular Cavity or Large Peripheral Vein Acidosis in cardiac arrest (given at the same time as other standard procedures are being applied).
If chest is open. Adults: 62-185 mL (2-6 g) into the ventricular cavity (not into the cardiac muscle). If chest closed. Adults: 111-333 mL (3.6-10.8 g) into a large peripheral vein.
?Addition to Pump Oxygenator Acid Citrate Dextrose Blood For acidity in ACD blood.
15-77 mL (0.5-2.5 g) added to each 500 mL of ACD blood. Usually 62 mL (2 g) added to 500 mL of ACD blood is adequate.

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