or hypokalemia. The calculated 1 3 deficit reflects only the present situation and does not account for ongoing H+ production and ^ ICO 3 loss. When giving


therapy, serial blood gases are needed to monitor therapy.

Another option for patients with severe acidemia is tromethamine (THAM). This inert amino alcohol buffers acids and CO2 through its amine (-NH2) moiety:


Protonated THAM (with CI or is excreted in the urine at a rate that is slightly higher than creatinine clearance. As such, THAM augments the buffering capacity of the blood without generating excess CO2. THAM is less effective in patients with renal failure and toxicities may include hyperkalemia, hypoglycemia, and possible respiratory depression.

Chronic metabolic acidosis can successfully be managed using potassium citrate/ citric acid (Polycitra-K) or sodium citrate/citric acid (Bicitra).

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