Tromethamine

Administration

• Type: Tham: 30 mEq/100 mL (500 mL) [latex free]
• Dosage Forms:
• Routes of Administration: IV
• Common Trade Names: THAM

Adult Dosing

Metabolic acidosis

• Estimated dose when buffer base deficit is known: IV: tromethamine dose (mL of 0.3 M solution) = body weight (kg) x base deficit (mEq/L) x 1.1.
• Initial: 111 to 333 mL of 0.3 M solution (3.6 to 10.8 g); additional amounts may be required to control acidosis after arrest reversed.

Pediatric Dosing

Metabolic acidosis

• Infants, Children, and Adolescents: IV: Empiric dosage calculation equation based upon base deficit:
• Dose (mL) of THAM = body weight (kg) x base deficit (mEq/L) x 1.1*

Special Populations

Pregnancy Rating

• Unknown

Lactation risk

• Unknwon

Renal Dosing

• Adult: There are no dosage adjustments provided in the manufacturer’s labeling.
• Pediatric: There are no dosage adjustments provided in the manufacturer’s labeling.

Hepatic Dosing

• Adult: There are no dosage adjustments provided in the manufacturer’s labeling.
• Pediatric: There are no dosage adjustments provided in the manufacturer’s labeling.

Contraindications

• Allergy to class/drug
• Uremia or anuria; chronic respiratory acidosis (neonates); salicylate intoxication (neonates).

Adverse Reactions

Serious

• Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during administration; avoid extravasation. May cause tissue inflammation, sloughing, and necrosis.
• Hypoglycemia: May cause hypoglycemia with rapid administration or extremely large doses; monitor serum blood glucose during and after therapy.
• Respiratory depression: Large doses may decrease respiratory ventilation due to increased blood pH and reduced CO2; adjust dose so that blood pH is not increased above normal. Monitor closely especially if patient not intubated. In patients with concomitant respiratory acidosis, use only with mechanical ventilation.

Pharmacology

• Half-life:
• Metabolism: None known.
• Excretion: Urine (>75%) within 8 hours.

Mechanism of Action

• 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.