arrest. acidosis is nearly always one of the consequences of cardiac arrest and, in some instances, may even be a causative factor in arrest. it is important therefore, that the correction of acidosis should be started promptly with other resuscitative efforts. by correcting acidosis, tham solution (tromethamine injection) has caused the arrested heart to respond to resuscitative efforts after standard methods alone had failed. in these cases, tromethamine was given intraventricularly. it is to be noted, however, that such precariously ill patients often have died subsequently of causes unrelated to the administration of tromethamine. with administration by the peripheral venous route, metabolic acidosis has been corrected in a majority of patients. the success in reinstitution of cardiac rhythm by this means probably has not been of the same order of magnitude as with the intraventricular route.

oid overdosage and alkalosis. overdosage in terms of total drug and/or too rapid administration, may cause hypoglycemia of a prolonged duration (several hours). therefore, frequent blood glucose determinations should be made during and after therapy. extreme care should be exercised in patients with renal disease or reduced urinary output because of potential hyperkalemia and the possibility of a decreased excretion of tromethamine. in such patients, the drug should be used cautiously with electrocardiographic monitoring and frequent serum potassium determinations. because clinical experience has been limited generally to short-term use, the drug should not be administered for more than a period of one day except in a life-threatening situation. the intravenous administration of tham solution can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema. additives may be incompatible. consult with pharmacist, if available. when introducing additives, use aseptic technique, mix thoroughly and do not store.

during the period of illness will depend upon the severity and progression of the acidosis. the possibility of some retention of tromethamine, especially in patients with impaired renal function, should be kept in mind. the intravenous dosage of tham solution (tromethamine injection) may be estimated from the buffer base deficit of the extracellular fluid in meq/liter determined by means of the siggaard-andersen nomogram. the following formula is intended as a general guide: tham solution (ml of 0.3 m) required = body weight (kg) x base deficit (meq/liter) x 1.1* thus, a 70 kg patient with a buffer base deficit (“negative base excess”) of 5 meq/liter would require 70 x 5 x 1.1 = 385 ml of tham solution containing 13.9 g (115 meq) of tromethamine. the need for administration of additional tham solution is determined by serial determinations of the existing base deficit. * factor of 1.1 accounts for an approximate reduction of 10% in buffering capacity due to the presence of sufficient acetic acid to lower ph of the 0.3 m solution to approximately 8.6. correction of metabolic acidosis associated with cardiac bypass surgery: an adverse dose of approximately 9.0 ml/kg (324 mg/kg) has been used in clinical studies with tham solution (tromethamine injection). this is equivalent to a total dose of 630 ml (189 meq) for 70 kg patient. a total single dose of 500 ml (150 meq) is considered adequate for most adults. larger single doses (up to 1000 ml) may be required in unusually severe cases. it is recommended that individual doses should not exceed 500 mg/kg (227 mg/lb) over a period of not less than one hour. thus, for a 70 kg (154 pound) patient the dose should not exceed a maximum of 35 g per hour (1078 ml of a 0.3 m solution). repeated determinations of ph and other clinical observations should be used as a guide to the need for repeat doses. correction of acidity of acd blood in cardiac bypass surgery: the ph of stored blood ranges from 6.80 to 6.22 depending upon the duration of storage. the amount of tham solution used to correct this acidity ranges from 0.5 to 2.5 g (15 to 77 ml of a 0.3 m solution) added to each 500 ml of acd blood used for priming the pump-oxygenator. clinical experience indicates that 2 g (62 ml of a 0.3 m solution) added to 500 ml of acd blood is usually adequate. correction of metabolic acidosis associated with cardiac arrest: in the treatment of cardiac arrest, tham solution should be given at the same time that other standard resuscitative measures, including manual systole, are being applied. if the chest is open, tham solution is injected directly into the ventricular cavity. from 2 to 6 g (62 to 185 ml of a 0.3 m solution) should be injected immediately. do not inject into the cardiac muscle. if the chest is not open, from 3.6 to 10.8 g (111 to 333 ml of a 0.3 m solution) should be injected immediately into a larger peripheral vein. additional amounts may be required to control acidosis persisting after cardiac arrest is reversed. correction of metabolic acidosis associated with rds in neonates and infants: the initial dose of tham solution should be based on initial ph and birthweight amounting to approximately 1 ml per kg for each ph unit below 7.4. further doses have been given according to changes in p a o 2 , ph and pco 2 . parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit (see contraindications ).

the site of injection, venous thrombosis or phlebitis extending from the site of injection extravasation and hypervolemia. if an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

daily requirement ranges from two to three liters (1.0 to 1.5 liters each for insensible water loss by perspiration and urine production). water balance is maintained by various regulatory mechanisms. water distribution depends primarily on the concentration of electrolytes in the body compartments and sodium (na + ) plays a major role in maintaining physiologic equilibrium.