To the Editor:—
We are aware that THAM is not only an "in vivo," but an "in vitro" buffer. To express so in our paper would have been redundant. Samiy's1 work on the interference with the [H+]-[Na+] exchange mechanism, and other electrolytes proves our contention, as demonstrated by Giotti and Meynert2 and also by Waddell and Butler,3 that such will interfere with the passive reabsorption of the unionized barbiturate ion in the proximal tubules. The plasma pH of 7.50-7.60, wherein this interference works best, is also ideal in forcing the barbiturate ion from intracellular extracellularly.As to adequacy of respiration, we have in our recovery room, a Monagham and a Wright Ventilometer. Comatose patients are tested for tidal exchange and minute volume at regular intervals. We agree with Dr. Nahas that the venous constriction caused by THAM is due to alkalinity (demonstrated in rabbit ear veins ), but
Balagot RC, Tsuji H, Sadove MS. Remarks on the Clinical Use of Tromethamine (THAM)-Reply. JAMA. 1962;180(6):511. doi:10.1001/jama.1962.03050190073022
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