Trometamol

Trometamol is a proton acceptor that generates NH₃ ⁺/HCO₃ ^- without generating CO₂, and the protonated R-NH₃ ⁺ is eliminated by the kidneys. Trometamol is the buffer of choice in the situation where CO₂ elimination is impaired (in which case NaHCO₃ cannot correct acidemia), and to avoid a Na⁺ load. Even during short intervals of apneic oxygenation when CO₂ elimination is curtailed, trometamol, but not bicarbonate, will maintain a normal arterial pH. Trometamol also acts as an osmotic diuretic, increasing urine flow, urinary pH, and excretion of fixed acids, carbon dioxide and electrolytes. A significant fraction of trometamol is not ionized and therefore is capable of reaching equilibrium in total body water. This portion may penetrate cells and may neutralize acidic ions of the intracellular fluid. ^[1]

The drug is rapidly eliminated by the kidney; 75% or more appears in the urine after eight hours. Urinary excretion continues over a period of three days. The maximum daily dose is 15 mmol/kg for an adult. In large doses, trometamol may induce respiratory depression and hypoglycemia. ^[1]