Pediatric Metabolic Acidosis Medication

Updated: Dec 31, 2019
  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Medication Summary

Specific therapies are directed at the underlying disease process that causes metabolic acidosis. However, sodium bicarbonate and tromethamine (also called THAM or tris [hydroxymethyl]-aminomethane) are used to address the acidosis itself.


Alkalinizing agents

Class Summary

Sodium bicarbonate is used as a gastric, systemic, and urinary alkalinizer and has been used in the treatment of acidosis resulting from metabolic and respiratory causes, including, diarrhea, kidney disturbances, and shock. Alternatively, THAM is a buffering agent that increases pH without increasing levels of PaCO2. It may be used to correct metabolic acidosis if sodium bicarbonate is contraindicated.

Sodium bicarbonate

Sodium bicarbonate serves as a buffering agent for metabolic acidosis when significant bicarbonate losses have occurred.

Tromethamine (THAM)

THAM combines with hydrogen ions to form bicarbonate buffer. It is used to prevent and correct systemic acidosis. It is available as 0.3-mol/L IV solution containing 18 g (150 mEq) per 500 mL (0.3 mEq/mL).



Class Summary

Vitamins are essential to normal metabolism.


Thiamine is an essential coenzyme that combines with ATP to form thiamine pyrophosphate. The dosage forms include a parenteral injection (100 mg/mL) and tablets. Thiamine administration rapidly corrects the clinical symptomatology in metabolic acidosis.