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Pronunciation |
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(troe
METH a
meen) |
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U.S. Brand
Names |
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THAM-E® Injection; THAM®
Injection |
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Generic
Available |
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No |
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Synonyms |
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Tris Buffer; Tris(hydroxymethyl)aminomethane |
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Pharmacological Index |
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Alkalinizing Agent |
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Use |
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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) |
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Uremia or anuria; chronic respiratory acidosis |
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Warnings/Precautions |
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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 |
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Adverse
Reactions |
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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
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Overdosage/Toxicology |
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Symptoms of overdose include alkalosis, hypokalemia, respiratory depression,
hypoglycemia
Supportive therapy is required to correct electrolyte, osmolality, and
abnormalities |
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Mechanism of
Action |
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Acts as a proton acceptor, which combines with hydrogen ions to form
bicarbonate buffer, to correct acidosis |
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Pharmacodynamics/Kinetics |
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Absorption: 30% of dose is not ionized
Elimination: Rapidly eliminated by kidneys (>75% in 3 hours)
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Usual Dosage |
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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 |
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Administration |
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Maximum concentration: 0.3 molar; infuse slowly over at least 1 hour
(Tham-E® requires the reconstitution with 1 L sterile
water before use) |
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Monitoring
Parameters |
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Serum electrolytes, arterial blood gases, serum pH, blood sugar, EKG
monitoring, renal function tests |
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Reference Range |
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Blood pH: 7.35-7.45 |
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Mental Health: Effects
on Mental Status |
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None reported |
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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Increase dietary potassium intake |
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Nursing
Implications |
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If extravasation occurs, aspirate as much fluid as possible, then infiltrate
area with procaine 1% to which hyaluronidase has been added |
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Dosage Forms |
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Injection:
THAM-E®: 36 g with sodium 30 mEq, potassium 5 mEq, and
chloride 35 mEq (1000 mL) |
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