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Discussion

THAM solution

So just got a patient out of the OR today that was a cocaine OD that had a type A dissection as well as a leaking AAA. Had an ischemic gut that was stented and fixed and had a cold leg that required a fem fem bypass. The type A wasn't able to be repaired and they are planning on doing it tomorrow if he makes it. My question is he came out with THAM solution for his massive base deficit. I've never seen this and talking with the CRNA they just said it was like a bicarb gtt. Just wanting some more info on this medication from an anesthesia stand point because I've never personally used it or seen it for an acidotic state.

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I have seen it used on rare occasions. it is a blood alkalizer used to treat meatabolic acidosis (not repiratory). I think it is used in OR as well to prime the bypass machine...maybe someone from OR knows more. Because of its basic ph you should be cautious when administering anything with it or piggybacking anything into b/c of its ph it probably would be incompatable with lots of other IV meds. I will have to look it up too. I have also heard it called Tham-E

I think I used THAM once in the ICU, not seen it used yet in my time as a CRNA. My understanding of THAM was that, like you said, it is like a bicarb gtt, but it doesn't metabolize back into CO2. If you give bicarb to anyone on an end tidal CO2 monitor, you will see just how much bicarb converts into CO2 by the spike in etco2. In the big picture, bicarb is a short term solution for base deficit that in the long run can actually contribute to acidosis. The theoretical benefit of Tham is that it shifts the bodies pH back toward 7.4 without CO2 as a biproduct (*I think). At one point I could do equations with avagadro's number and find how much co2 was contained in an amp of bicarb and stuff like that, but no longer. Anyway, this is just off the top of my head, so if I'm wrong, please correct me.

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