Dose:  mls of 0.3 M THAM = weight (kg) x base deficit (mEq/l) x 1.1
            Total dose should not exceed 40 ml/kg/Day

Contraindication: Anuria

Comments: Tromethamine (THAM) is a highly alkaline, sodium-free organic amine, used to treat metabolic acidosis or induce alkalosis.   It combines with hydrogen ions from carbonic acid to form bicarbonate and a cationic buffer. It also acts as an osmotic diuretic, increasing urine flow, urinary pH and excretion of fixed acids, carbon dioxide and electrolytes. It is rapidly excreted from the kidneys, most of drug is removed by 8 hours following administration.  It should be administered through a large vein as it is quite sclerosing. Avoid giving through UAC. Hemorrhagic necrosis of the liver has occurred after the infusion of 1.2 M THAM through a UVC. If the UAC or UVC are used, the correct position of the vascular line must be assured. The base deficit is derived using the Siggaard-Andersen nomogram and the pH and pCO₂ obtained from ABGs. In an emergency, 10 cc/kg of 0.3 M THAM can be given. Do not use if the infant has anuria or uremia.  Further comments on tromethamine.

Toxicity: Reported side effects include local tissue reaction and necrosis. If a peripheral IV is used, the extremity should be elevated during the infusion. INFANTS HAVE DEVELOPED RESPIRATORY DEPRESSION AND APNEA FOLLOWING INFUSIONS OF THAM. In experimental animals, THAM has been associated with hypoglycemia and hyperkalemia, although no changes in serum glucose or potassium concentrations were noted in two study groups of infants.

Preparation: Tromethamine (THAM) is available in a  0.3 M solution (3.6 gram or 30 mEq THAM/100 ml) in a 500 ml bottle.   Stable for 24 hours at room temperature after bottle opened.

Compatibility: Not compatible with TPN no information on filter or other medications.