THAM


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tromethamine

Tham

Pharmacologic class: Protein substrate

Therapeutic class: Systemic alkalizer

Pregnancy risk category C

Action

Combines with hydrogen ions to form bicarbonate and a buffer, correcting acidosis. Also shows some diuretic activity.

Availability

Injection: 18 g/500 ml

Indications and dosages

Metabolic acidosis associated with cardiac bypass surgery

Adults: 9 ml/kg (0.32 g/kg) by slow I.V. infusion; 500 ml (18 g) is usually adequate. Maximum single dosage is 500 mg/kg infused over at least 1 hour.

Metabolic acidosis associated with cardiac arrest

Adults: 3.6 to 10.8 g by I.V. injection into large peripheral vein if chest isn't open, or 2 to 6 g I.V. directly into ventricular cavity if chest is open. After reversal of cardiac arrest, patient may need additional amounts to control persistent acidosis.

To correct acidity of acid-citrate-dextrose (ACD) blood in cardiac bypass surgery

Adults: 0.5 to 2.5 g added to each 500 ml of ACD blood used for priming pump-oxygenator. Usual dosage is 2 g.

Dosage adjustment

• Elderly patients

Contraindications

• Hypersensitivity to drug

• Anuria

• Uremia

Precautions

Use cautiously in:

• renal disease, severe respiratory disease, respiratory depression

• pregnant patients

• infants.

Administration

Keep intubation equipment nearby in case respiratory depression occurs.

• For metabolic acidosis associated with cardiac bypass surgery, give by slow I.V. infusion through large-bore I.V. catheter into large antecubital vein. Elevate arm after infusion.

• If extravasation occurs, discontinue drug and infiltrate affected area with 1% procaine hydrochloride (containing hyaluronidase).

• Be aware that in cardiac arrest, drug is used with standard resuscitative measures. When giving by direct I.V. injection into open chest, never inject into cardiac muscle.

Adverse reactions

GU: oliguria

Hepatic: hemorrhagic hepatic necrosis

Metabolic: metabolic alkalosis, transient hypoglycemia, fluid-solute overload, hyperkalemia

Respiratory: respiratory depression

Other: fever; I.V. site infection; extravasation with venous thrombosis or phlebitis, inflammation, necrosis, and sloughing

Interactions

Drug-diagnostic tests. Glucose: decreased level

Potassium: increased level

Patient monitoring

• Maintain continuous cardiac monitoring.

• Monitor arterial blood gas levels. Watch for alkalosis and signs and symptoms of respiratory depression.

• Assess liver function tests. Stay alert for signs and symptoms of hepatic impairment.

• Monitor glucose and potassium levels. Watch for hypoglycemia and hyperkalemia.

• Closely monitor fluid intake and output. Check for fluid and electrolyte imbalances and oliguria related to hyperkalemia.

Patient teaching

• Explain drug therapy to patient. Assure him he will be monitored continuously.

• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.

THAM

Tris(hydroxymethyl)aminomethane, Tris buffer Emergency medicine An amine proton donor administered IV during early CPR to treat lactic acidosis
References in periodicals archive ?
If shareholders back the plan, Mr Tham will emerge with a 22 per cent stake in the enlarged share capital and become the company's chairman, replacing Walter Goldsmith, who becomes a non-executive director.
Next to Nuneaton's ring road, the Thai Tham has no on-street parking option, but it is a stone's throw from the town centre, so plenty of car parks and streets to choose from.
But Gibbons and Tham rallied well against the top pair to take their reverse doubles to 17 in the third to leave North one away from victory.
Massey Knakal announced that Mack Tham, who joined the company in the Fall of 2006 as a director of sales in Brooklyn, has decided to relocate to the Queens office to exclusively cover Flushing.
TRICKS OF THE TRADE: Matt Adams entertains Andrew Tham (left) and Dale Dunn and raises smiles at the dinner table at TGI Fridays with his tricks (below).
Jolie tossed plastic soccer balls to the throngs of enthusiastic children who greeted her aircraft at the Tham Hin refugee camp in Ratchaburi province, 59 miles west of Bangkok.
For notification of market consultation, More information about the arenas and the procedure for the "competitive dialogue" you can contact julie tham (program kibo): Julie.
A 3-1 deficit was to become 5-1 with the loss of both opening men's doubles, but Martin Fagan and Carl Gibbons only lost narrowly in three and Andy Tham and Steven Gibbons, although defeated in two sets, went down by only two points.
Massey Knakal Realty Services is pleased to announce that Mack Tham has joined their Brooklyn office as its newest broker, covering the Flatlands and Marine Park sections of the borough.
Suey Tham, daughter of Mr Phong and Mrs Kenh Tham, of Maureen Close, Tile Hill, Coventry, and Spencer Bilke, son of Keith and Meagan Bilke, of Lesingham Drive, Tile Hill, Coventry, at the Royal Court Hotel, Keresley, Coventry, on August 30.
Andy Tham and Steven Gibbons then did well to come from a set down to beat their opposite numbers and keep North in it at 5-3 down.