November 18, 1968

Hepatic Injury Related to Tromethamine

JAMA. 1968;206(8):1793. doi:10.1001/jama.1968.03150080073022

To the Editor:—  The paper by Goldenberg et al (205:81, 1968) describing liver damage in infants receiving concentrated tromethamine (THAM) solution (1.2M, pH 10.2) through the umbilical vein confirms previous observations. Indeed, a review of the literature concerning the effect of the infusion of hypertonic alkaline solutions indicates that such administration does produce liver damage. Brinkman et al1 reported in 1961 that administration of 1.5M tromethamine (pH 10.2) in a diabetic patient who subsequently died presented hydropic degeneration of liver cells as well as kidney. In 1963, it was reported that fetal rhesus monkeys treated by injection of sodium carbonate (pH 10.5, 0.7M solution, 2,100 mOsm) into the umbilical vein were found to have liver damage at the time of postmortem examination.2 This damage was described as areas of hemorrhage with necrosis of liver cells. By contrast, diabetic patients treated with tromethamine (0.3M) did not present any microscopic