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Pediatric Respiratory Acidosis Medication

  • Author: Mithilesh K Lal, MBBS, MD, MRCP, FRCPCH; Chief Editor: Timothy E Corden, MD  more...
Updated: Jun 05, 2014

Medication Summary

Mechanical ventilation is the mainstay of therapy for respiratory failure associated with hypercapnia until the precipitating disease state can be reversed. Tromethamine (THAM) has been used to prevent and correct systemic or respiratory acidosis. Sodium bicarbonate (NaHCO3) is sometimes employed but should be administered with caution if used.


Alkalinizing agents

Class Summary

Treatment of a concurrent metabolic acidosis or buffering the acidemia with a respiratory acidosis can be considered. In certain cases, THAM may be helpful.

Tromethamine (THAM)


THAM, also known as tris[hydroxymethyl]-aminomethane, is used to prevent and correct systemic or respiratory acidosis. It is a biologically inert weak base that can buffer excess carbon dioxide. It combines with hydrogen ions to form bicarbonate (HCO3–) buffer, as follows:

R-NH2 + CO2 + H2O = R-NH3 + HCO3

At 37°C, pKa is 7.8; therefore, THAM is a more effective buffer than NaHCO3– in the physiologic blood pH range. It is not protein bound and is distributed primarily in extracellular space. When protonated, THAM is excreted by the kidneys and acts as an osmotic diuretic. It is most appropriately administered as a short-term infusion during the therapeutic window to correct acute respiratory acidosis.

Contributor Information and Disclosures

Mithilesh K Lal, MBBS, MD, MRCP, FRCPCH MRCP, MRCPCH, FRCPCH, Consultant Neonatologist, James Cook University Hospital, UK

Mithilesh K Lal, MBBS, MD, MRCP, FRCPCH is a member of the following medical societies: British Medical Association, Royal College of Physicians, Royal College of Paediatrics and Child Health, British Association of Perinatal Medicine, American Pediatric Society, Society for Pediatric Research, Neonatal Society, Nepal Medical Association

Disclosure: Nothing to disclose.


Ronald Litman, DO Professor of Anesthesiology and Pediatrics, University of Pennsylvania School of Medicine

Ronald Litman, DO is a member of the following medical societies: American Academy of Pediatrics, American Society of Anesthesiologists, Society for Pediatric Anesthesia

Disclosure: Nothing to disclose.

Margaret A Priestley, MD Associate Professor of Clinical Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania; Clinical Director, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia

Margaret A Priestley, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.


G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, University of Miami, Leonard M Miller School of Medicine; Chief, Division of Pediatric Critical Care Medicine, Medical Manager, Urban Search & Rescue, South Florida TF-2, Medical Director, Holtz Children's Hospital Palliative Care Team, Medical Director, Tilli Kids – Pediatric Initiative of Hospice Care of SE Florida, Director, Pediatric Critical Care Transport, Holtz Children's Hospital/Jackson Memorial Hospital

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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