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May 12, 1962

Remarks on the Clinical Use of Tromethamine (THAM)

Author Affiliations

630 W. 168th St., New York City 32

JAMA. 1962;180(6):511. doi:10.1001/jama.1962.03050190073021

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To the Editor:—  On the basis of experimental work during the past 3 1/2 years we cannot concur with some of the statements made by R. C. Balagot et al. on "THAM in Barbiturate Poisoning" (JAMA178:-1000 [Dec. 9] 1961).To classify THAM as an "in vivo buffer" ignores its use in vitro for 10 years (Analyt Chem23:491, 1951) before its introduction in vivo (Science129:-782, 1959). In addition, Samiy's work (Ann NY Acad Sci92:570, 1961) and our own indicates that THAM exerts its action not only through its osmotic properties, but also by interfering with the (H+)-(Na+) exchange mechanism in the distal tubular cells. This interference would be especially marked at a plasma pH of 7.50-7.70, since 40% of THAM would be unionized.It is not informative to merely state that "respiratory rate and volume were judged adequate," since it has been reported

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