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amadeusz.ziarkowski
#1 Posted : Tuesday, January 14, 2014 6:08:26 AM(UTC)
I'm interested in US experience of use of THAM (tromethamol) as a buffer in critically ill patients (e.g. in ARDS with permissive hypercapnia).
 1 user thanked amadeusz.ziarkowski for this useful post.
evelyn.mckinney on 1/15/2014(UTC)
gflear
#2 Posted : Wednesday, January 15, 2014 3:51:28 PM(UTC)
Quickly I can say that THAM can be used in place of bicarbonate to treat acidosis as THAM does not produce CO2 in its reaction, so it may be a better solution in the presence of permissive hypercapnea.
More to follow...
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amadeusz.ziarkowski on 1/16/2014(UTC)
amadeusz.ziarkowski
#3 Posted : Thursday, January 16, 2014 1:32:07 PM(UTC)
Thanks for you response. This is what I expected of THAM. Any clinical experience with it in critical care setting? Is it being used or its use is only anecdotal? Does it really work as predicted? Are there protocols for its use or is it just on individual patient basis?
gflear
#4 Posted : Thursday, January 16, 2014 1:40:24 PM(UTC)
I have found a few articles on THAM with traumatic brain injury and found that I was remotely involved (lots of travel to CT scan)in one of the original studies in 1993. It appears THAM is quite effective in controlling ICP in traumatic head injury. I know a critical care pharmacist, I'll pass a note along to them and see what they have to say.
 1 user thanked gflear for this useful post.
amadeusz.ziarkowski on 1/17/2014(UTC)
gflear
#5 Posted : Friday, January 17, 2014 9:19:08 AM(UTC)
Hi, I have communicated with my Pharm.D friend. Said, yes in theory and in studies THAM is good for correcting acidosis without raising CO2 and is good for lowering ICP in traumatic brain injuries, but is not often used for a few reasons; It is expensive, in these days of drug shortages it is often in short supply and hard to find. It may cause hyperkalemia and hypoglycemia and it is easy to overshoot dosage and end up alkalotic. Should probably not be used in patients with renal impairment because of the hyperkalemia and many of our ARDS folks do have some renal insufficiency as well.
 1 user thanked gflear for this useful post.
amadeusz.ziarkowski on 1/17/2014(UTC)
amadeusz.ziarkowski
#6 Posted : Friday, January 17, 2014 9:31:57 AM(UTC)
Many thanks for your response again. It was very useful.
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