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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
Nahas GG. Remarks on the Clinical Use of Tromethamine (THAM). JAMA. 1962;180(6):511. doi:10.1001/jama.1962.03050190073021
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