Dosing and uses of Tham (tromethamine)
Adult dosage forms and strengths
infusion solution
- 0.3M
Alkalinizing Agent
Tham Solution (mL of 0.3 M) required = Body Weight (kg) x Base Deficit (mEq/L) x 1.1 given by IV infusion
Cardiac arrest with metabolic acidosis: IV 3.6-10.8 g, maximum 500 mg/kg/dose
Cardiac arrest with metabolic acidosis if chest open: 2-6 g injected directly into ventricular cavity, avoid cardiac muscle
Cardiac bypass surgery with acidosis: 9 mL/kg IV, maximum 500 mg/kg
Pediatric dosage forms and strengths
As adult
Tham (tromethamine) adverse (side) effects
Frequency not defined
Alkalosis
Hypervolemia
Venospasm
Hyperkalemia
Hypoglycemia (usu doses >500 mg/kg over <1hr)
Hepatic necrosis (resulted during delivery via umbilical venous catheter)
Necrosis with extravasation
Phlebitis
Tissue irritation
Apnea
Pulmonary edema
Respiratory depression
Warnings
Contraindications
Uremia
Anuria
Neonates: chronic respiratory acidosis, salicylate intoxication
Cautions
Renal impairment
Extravasation may cause inflammation & tissue necrosis
Administer slowly to avoid alkalosis
Risk of overhydration, that may cause serum electrolyte dilution, pulm edema, CHF
Risk of hypoglycemia in preemies & neonates
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if present in breast milk, use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Tham (tromethamine)
Metabolism: N/A
Excretion: urine
Mechanism of action
Basic chemical, pHed to 8.6 w/ acetic acid
Administration
IV Administration
Slow intravenous infusion, by addition to pump-oxygenator ACD blood or other priming fluid or by injection into ventricular cavity during cardiac arrest
If infused into peripheral vein, use large needle in largest antecubital vein or indwelling catheter placed in large vein of an elevated limb to minimize chemical irritation of alkaline solution
Catheters recommended.
Storage
Contains no preservatives/antibacterials; discard unused portion
