Parenteral Manual

Tromethamine

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Alternate Name(s): 
THAM
Classification: 
Alkalininzing agent
Original Date: 
September 2011
Revised Date: 
Indications: 
  • Correction of metabolic acidosis asoociated with cardiac bypass sugery, cardiac arrest, or status asthmaticus
  • In severe metabolic acidosis in patients in whom sodium or carbon dioxide elimination is restricted  -eg. infants needing alkalinization after receiving maximum sodium bicarbonate
    (8-10 mmol/kg/24 hours)
Reconstitution and Stability: 
  • 36 mg/mL in 500 mL glass bottle (0.3 M)
  • Store at room temperature
Compatibility: 

-Incompatible:  penicillin, TPN

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES  -CENTRAL LINE  only
Usual dilution: 36 mg/mL (0.3M)
Infusion time:  1 hour
Infusion rate:  3-16 mL/kg/hour up to 33-40 mL/kg/day
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Infant, children and adult:

  • Empiric dosage based upon base deficit: tromethamine mL of 36 mg/mL (0.3 M )solution = body weight (kg) x base deficit (mEq/L) x 1.1*; maximum: 500 mg/kg/dose = 13.9 mL/kg/dose using 0.3 M solution

    *Factor of 1.1 accounts for an approximate reduction of 10% in buffering capacity due to the presence of sufficient acetic acid to lower the pH of the 0.3 M solution to approximately 8.6

  • Metabolic acidosis with cardiac arrest: 3.5-6 mL/kg/dose (126-216 mg/kg/dose); maximum: 500 mg/kg/dose = 13.9 mL/kg/dose

Potential hazards of parenteral administration: 

  • Avoid infusion via low-lying umbilical venous catheters due to associated risk of hepatocellular necrosis

  • Extravasation will cause severe local tissue necrosis and sloughing

  • Rapid I.V. infusion and overdosage may cause prolonged hypoglycemia

  • If extravasation occurs, discontinue tromethamine immediately and consider local infiltration of phentolamine

     

Notes: 
  • 1 mM = 120 mg = 3.3 mL = 1 mEq of THAM
  • In renal impairment:  reduce dose and monitor pH and serum potassium
  • Monitor Serum electrolytes, arterial blood gases, serum pH, blood sugar, ECG monitoring, renal function tests

  • Monitor pH carefully as large doses may increase blood pH greater than normal which may result in depressed respiration.

References: 

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