No

Alkalinizing Agent

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; to prime the pump-oxygenator during cardiac bypass surgery; indicated in infants needing alkalinization after receiving maximum sodium bicarbonate (8-10 mEq/kg/24 hours); (advantage of Tham® is that it alkalinizes without increasing pCO₂ and sodium)

C

Uremia or anuria; chronic respiratory acidosis

Reduce dose and monitor pH carefully in renal impairment; drug should not be given for a period of longer than 24 hours unless for a life-threatening situation

1% to 10%:

Cardiovascular: Venospasm

Local: Tissue irritation, necrosis with extravasation

<1%: Hyperosmolality of serum, hyperkalemia, hypoglycemia (transient), increased blood coagulation time, liver cell destruction from direct contact with THAM®, apnea, respiratory depression

Symptoms of overdose include alkalosis, hypokalemia, respiratory depression, hypoglycemia

Supportive therapy is required to correct electrolyte, osmolality, and abnormalities

Acts as a proton acceptor, which combines with hydrogen ions to form bicarbonate buffer, to correct acidosis

Absorption: 30% of dose is not ionized

Elimination: Rapidly eliminated by kidneys (>75% in 3 hours)

Dose depends on buffer base deficit; when deficit is known: tromethamine (mL of 0.3 M solution) = body weight (kg) x base deficit (mEq/L); when base deficit is not known: 3-6 mL/kg/dose I.V. (1-2 mEq/kg/dose)

I.V.: 3.5-6 mL/kg (1-2 mEq/kg/dose) into large peripheral vein; 500-1000 mL if needed in adults

I.V. continuous drip: Infuse slowly by syringe pump over 3-6 hours

Acidosis associated with cardiac bypass surgery: Average dose: 9 mL/kg (2.7 mEq/kg); 500 mL is adequate for most adults; maximum dose: 500 mg/kg in less than or equal to 1 hour

Excess acidity of acid citrate dextrose priming blood: 14-70 mL of 0.3 molar solution added to each 500 mL of blood

Dosing comments in renal impairment: Use with caution and monitor for hyperkalemia and EKG

Maximum concentration: 0.3 molar; infuse slowly over at least 1 hour (Tham-E® requires the reconstitution with 1 L sterile water before use)

Serum electrolytes, arterial blood gases, serum pH, blood sugar, EKG monitoring, renal function tests

Blood pH: 7.35-7.45

None reported

None reported

No information available to require special precautions

No effects or complications reported

Increase dietary potassium intake

If extravasation occurs, aspirate as much fluid as possible, then infiltrate area with procaine 1% to which hyaluronidase has been added

Injection:

THAM-E®: 36 g with sodium 30 mEq, potassium 5 mEq, and chloride 35 mEq (1000 mL)