THAM (trometanol; tris-hydroxymethyl aminomethane)

Your Patient In Extremis: THAM To The Rescue?

AliEM - By Prathap Sooriyakumaran - October 5th, 2015

..."THAM (trometanol; tris-hydroxymethyl aminomethane) is an inert amino alcohol which is theoretically a more effective buffer than bicarbonate in the physiological range of blood pH because it has a pKa of 7.8 at normal body temperatures (compared to a pKa of 6.1 for sodium bicarbonate)...

THE EVIDENCE
You evidence-based-medicine fans may want to know about what the best in clinical trials has to say about patient outcomes with THAM. Well… nothing. In fact, there are no randomized clinical trials in humans showing that resolving acidosis (whether by THAM or bicarbonate) without fixing the cause improves outcomes. In the meantime, consider including THAM in your armamentarium when dealing with the critically sick, where severe acidemia is leading the patient down the path of no return.
OUR FINAL THOUGHTS
THAM should be considered in patients with severe acidemia causing instability with any of the following:

• Are being resuscitated from cardiac arrest 
• Are hypercapnic (COPD/asthma) 
• Are hypernatremic

THAM should be avoided in patients with any of the following:

• Hyperkalemia
• Significant volume overload
• Uremia or anuria (without a plan for dialysis)
• Salicylate toxicity

What is still needed?

• Robust research looking at outcomes with THAM versus bicarbonate versus placebo in patients with severe acidemia"

http://www.aliem.com/patient-extremis-tham-rescue/