tromethamine (Discontinued)

Brand and Other Names:Tham
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution

  • 0.3M (18 g)
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Metabolic Acidosis

No longer available in the United States

IV dosage estimation: Tromethamine solution (mL of 0.3 M) required = Body Weight (kg) x Base Deficit (mEq/L) x 1.1 given by IV infusion

Dosage Forms & Strengths

IV solution

  • 0.3M (18 g)

Metabolic Acidosis Associated with RDS

No longer available in the United States

1 mL/kg for each drop in pH below 7.4; determine additiona doses through changes in pH, PaO2, and pCO2

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Adverse 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

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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 with extremely large doses

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Pregnancy & 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.

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Pharmacology

Mechanism of Action

Corrects acidosis by acting as a proton acceptor; releases bicarbonate buffer to correct acidosis by combining with hydrogen ions

Pharmacokinetics

Distribution: Distributes into cellular extracellular space quickly; at steady state distributes into a volume slightly greater than total body water; penetrates slowly intracellularly

Half-life: 5.6 hr

Excretion: Urine within 8 hr (>75%)

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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

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