The Effect of “Tris-Hydroxymethyl Aminomethane” Treatment on Survival of Rats with Experimental Metabolic Acidosis Created by Intragastric Administration of Hydrochloric Acid
Abstract
Abstract
Background:
Treatment of acidosis is serious health problem within emergency departments and intensive care units etc. Ingestion of household cleaning solutions (due to both suicidal and accidental reasons) is still also a serious public health problem in Turkey and the most fatal complication thereof is, severe metabolic acidosis. An effective treatment should be provided for the cases presenting to emergency departments with life-threatening metabolic acidosis.
Aim:
We aimed to compare the survival rate of rats with experimental metabolic acidosis created by intragastric administration of hydrochloric acid and treated with “tris–hydroxymethyl aminomethane” or normal saline solution alone.
Study Design:
This was an experimental animal study
Methods:
Following ketamine-xylazine anesthesia, internal carotid artery of fourteen female Wistar albino rat was cannulated, basal blood samples were drawn and esophagus of each was cannulated with intracath. Hydrochloric acid was subsequently poured through the cannula towards stomach. After 30 minutes, blood gas status was checked in order to see if acidosis occurred or not. The rats which developed acidosis were randomly divided into “tris-hydroxymethyl aminomethane” and “normal saline solution” groups. Later the treatment with IV tris-hydroxymethyl aminomethane or normal saline was initiated. At 30th and 60th minutes of the treatment, pH, PaO2, HCO3, PaCO2 and base deficit parameters were checked through arterial blood gas samples to monitor the efficacy of the treatment. At the end of the second hour of the study, the experiment was finalized and the survival of rats was documented.
Results
Following the development of experimental metabolic acidosis in rats by ingestion of intragastric hydrochloric acid, four rats in tris–hydroxymethyl aminomethane and six rats in normal saline group died prior to the end of the follow-up period.
This finding was statistically significant. There was no statistically significant difference between tris–hydroxymethyl aminomethane and normal saline groups with regard to body temperature, blood pressure, heart rate, PaCO2 and PaO2. However, the comparison of two groups with respect to survival indicated a significant difference (p<0.05). pH at 60th minute in tris–hydroxymethyl aminomethane group was significantly lower compared to that in normal saline group (p<0.05), and base deficit values at 30th and 60th minutes in tris–hydroxymethyl aminomethane group were significantly higher compared to that in normal saline group (p<0.05).
Conclusion:
In this experimental rat model, we observed that treatment with IV tris–hydroxymethyl aminomethane prolonged the survival of rats with experimental metabolic acidosis created by ingestion of hydrochloric acid compared to the treatment with normal saline solution.
Supporting Institution
yok
Project Number
yok
Thanks
We would like to thank to Çiğdem Akalın Akkök, MD, PhD from the Department of Immunology and Transfusion Medicine, Section of Immunohematology, Oslo University Hospital, Ullevaal, Oslo, Norway for helping us to obtain the vials of tris-hydroxymethyl aminomethane (Tribonat™) from Norway, since it is unavailable in the medical market of Turkey.
References
- 1. hidroklorik asit uygulanan deneysel rat modelinde intravenöz sodyum bikarbonat tedavisinin sağ kalım üzerine etkisi. Dr. Berrin Kazancı, Uzmanlık Tezi (Dokuz Eylül Hastanesi, Acil Tıp Anabilim Dalı, İzmir, 2009). (Supervisor attending physician: Gürkan ERSOY, MD) (In Turkish).
- 2. Eray O, Eken C, Oktay C, Gelen T, Avcı AB. Comparison of systemic and local effects of nitric acid and hydrochloric acid: an experimental study in a rat model. Turkish Journal of Trauma & Emergency Surgery 2006;12:184-188.
- 3. Kardon E. M. Toxicity, Caustic Ingestions. http://emedicine.medscape.com/article/813772. Accessed at October 11, 2019.
- 4. Yanturali S, Aksay E, Atilla R. Acute myocardial infarction after hydrochloric acid ingestion. Mt Sinai J Med. 2005;72:(6):409-12.
- 5. Seyran BOZKURT (2009), Zehirlenmeler: Salim SATAR (ed.), Acilde Klinik Toksikoloji (Adana Nobel Kitapevi, ISBN 978 605 397 027 9), 555-561. (In Turkish).
- 6. Sutin KM, Fermon C, Streat S, Wiklund L, Wahlander S, Yellin P, et al. Guidelines for the Treatment of Acidaemia with THAM. Drugs 1998;55:91-224.
- 7. Holmdahl MH, Wiklund L, Wetterberg T, Streat S, Wahlander S, Sutin K, Nahas G. The place of THAM in the management of acidemia in clinical practice. Acta Anaesthesiol Scand 2000;44:524–527.
- 8. Bolatkale M, Ersoy G, Yanturali S, Yilmaz O, Can Ç, Acara A, et al. The Comparison of the Effects of “Trometamol; TrisHydroxymethylaminomethane” and “Sodium Bicarbonate” Treatments on Mortality and Survival Time in Experimental Metabolic Acidosis Induced by Methanol Intoxication. Eurasian J Emerg Med. 2018; 17: 22-7.
- 9. Tribonat™ (Tris-hydroxymethyl Aminomethane) (THAM) web site: http://www.felleskatalogen.no/medisin/tribonat-fresenius-kabi-564807. Acessed at September 20, 2019.
- 10. Marfo K, Garala M, Kvetan V, Gasperino J. Use of Tris–hydroxymethyl aminomethane in severe lactic acidosis due to highly active antiretroviral therapy: a case report. Journal of Clinical Pharmacy and Therapeutics 2009;34:119–123.
- 11. G. Richard Bruno, Wallace A. Carter (2011). Caustics. In; Judith E. Tintinalli, Gabor D. Kelen, J. Stephan Stapczynski (eds), Emergency Medicine A Comprehensive Study Guide, (McGraw-Hill, USA); p:1292-1297.
- 12. Kallet RH, Jasmer RM, Luce JM, Lin LH, Marks JD. The treatment of acidosis in acute lung injury with tris-hydroxymethyl aminomethane (THAM). Am J Respir Crit Care Med 2000;161:1149-53.
- 13. Scheiderman R., Rosenkrantz T.S., Knox I., Cramer R. Effects of a continuous infusion of tris hydroxymethyl aminomethane on acidosis, oxygen affinity, and serum osmolality. Biol Neonate 1993;64:287-294.
- 14. Sirieix D., Delayance S., Paris M. Tris-hydorxymethyl aminomethane and sodium bicarbonateto buffer metabolik acidosis in an isolated heart model. Am J Respir Crit Care Med;1997;155:957-963.
- 15. Sun JH, Filley GF, Hord K, Kindig NB, Bartle EJ. Carbicarb: an effective substitude for NaHCO3. Surgery 1987;102:835-839.
- 16. Weinberger T, Castel T, Bar-Joseph N, Laor A, Bursztein S, Ben Haim S. Comparison of sodium bicarbonate, Carbicarb and THAM during cardiopulmonary resuscitation in dogs. Crit Care Med 1998;26:1397-408.
- 17. Fisher RA, Eckhauser ML, Radivoyevitch M. Acid ingestion in an experimental model. Surgery, Gynecology&Obstetrics 1985;161:91-99.
- 18. Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. American Journal of Kidney Diseases 2001;38(4):703-727.
- 19. Rehm M., Finsterer U. Treating Intraoperative Hyperchloremic Acidosis with Sodium Bicarbonate or Tris-Hydroxymethyl Aminomethane: A Randomised Prospective Study. Anest Analg 2003;96:1201-8.
- 20. Bjerneroth, Gunnel. Tribonat (registered sign)-A comprehensive summary of its properties. Critical Care Medicine, 1999;27 (5):1009-1013.
- 21. Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lescot et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit www.thelancet.com Published online June 14, 2018 http://dx.doi.org/10.1016/S0140-6736(18)31080-8
Abstract
Project Number
yok
References
- 1. hidroklorik asit uygulanan deneysel rat modelinde intravenöz sodyum bikarbonat tedavisinin sağ kalım üzerine etkisi. Dr. Berrin Kazancı, Uzmanlık Tezi (Dokuz Eylül Hastanesi, Acil Tıp Anabilim Dalı, İzmir, 2009). (Supervisor attending physician: Gürkan ERSOY, MD) (In Turkish).
- 2. Eray O, Eken C, Oktay C, Gelen T, Avcı AB. Comparison of systemic and local effects of nitric acid and hydrochloric acid: an experimental study in a rat model. Turkish Journal of Trauma & Emergency Surgery 2006;12:184-188.
- 3. Kardon E. M. Toxicity, Caustic Ingestions. http://emedicine.medscape.com/article/813772. Accessed at October 11, 2019.
- 4. Yanturali S, Aksay E, Atilla R. Acute myocardial infarction after hydrochloric acid ingestion. Mt Sinai J Med. 2005;72:(6):409-12.
- 5. Seyran BOZKURT (2009), Zehirlenmeler: Salim SATAR (ed.), Acilde Klinik Toksikoloji (Adana Nobel Kitapevi, ISBN 978 605 397 027 9), 555-561. (In Turkish).
- 6. Sutin KM, Fermon C, Streat S, Wiklund L, Wahlander S, Yellin P, et al. Guidelines for the Treatment of Acidaemia with THAM. Drugs 1998;55:91-224.
- 7. Holmdahl MH, Wiklund L, Wetterberg T, Streat S, Wahlander S, Sutin K, Nahas G. The place of THAM in the management of acidemia in clinical practice. Acta Anaesthesiol Scand 2000;44:524–527.
- 8. Bolatkale M, Ersoy G, Yanturali S, Yilmaz O, Can Ç, Acara A, et al. The Comparison of the Effects of “Trometamol; TrisHydroxymethylaminomethane” and “Sodium Bicarbonate” Treatments on Mortality and Survival Time in Experimental Metabolic Acidosis Induced by Methanol Intoxication. Eurasian J Emerg Med. 2018; 17: 22-7.
- 9. Tribonat™ (Tris-hydroxymethyl Aminomethane) (THAM) web site: http://www.felleskatalogen.no/medisin/tribonat-fresenius-kabi-564807. Acessed at September 20, 2019.
- 10. Marfo K, Garala M, Kvetan V, Gasperino J. Use of Tris–hydroxymethyl aminomethane in severe lactic acidosis due to highly active antiretroviral therapy: a case report. Journal of Clinical Pharmacy and Therapeutics 2009;34:119–123.
- 11. G. Richard Bruno, Wallace A. Carter (2011). Caustics. In; Judith E. Tintinalli, Gabor D. Kelen, J. Stephan Stapczynski (eds), Emergency Medicine A Comprehensive Study Guide, (McGraw-Hill, USA); p:1292-1297.
- 12. Kallet RH, Jasmer RM, Luce JM, Lin LH, Marks JD. The treatment of acidosis in acute lung injury with tris-hydroxymethyl aminomethane (THAM). Am J Respir Crit Care Med 2000;161:1149-53.
- 13. Scheiderman R., Rosenkrantz T.S., Knox I., Cramer R. Effects of a continuous infusion of tris hydroxymethyl aminomethane on acidosis, oxygen affinity, and serum osmolality. Biol Neonate 1993;64:287-294.
- 14. Sirieix D., Delayance S., Paris M. Tris-hydorxymethyl aminomethane and sodium bicarbonateto buffer metabolik acidosis in an isolated heart model. Am J Respir Crit Care Med;1997;155:957-963.
- 15. Sun JH, Filley GF, Hord K, Kindig NB, Bartle EJ. Carbicarb: an effective substitude for NaHCO3. Surgery 1987;102:835-839.
- 16. Weinberger T, Castel T, Bar-Joseph N, Laor A, Bursztein S, Ben Haim S. Comparison of sodium bicarbonate, Carbicarb and THAM during cardiopulmonary resuscitation in dogs. Crit Care Med 1998;26:1397-408.
- 17. Fisher RA, Eckhauser ML, Radivoyevitch M. Acid ingestion in an experimental model. Surgery, Gynecology&Obstetrics 1985;161:91-99.
- 18. Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. American Journal of Kidney Diseases 2001;38(4):703-727.
- 19. Rehm M., Finsterer U. Treating Intraoperative Hyperchloremic Acidosis with Sodium Bicarbonate or Tris-Hydroxymethyl Aminomethane: A Randomised Prospective Study. Anest Analg 2003;96:1201-8.
- 20. Bjerneroth, Gunnel. Tribonat (registered sign)-A comprehensive summary of its properties. Critical Care Medicine, 1999;27 (5):1009-1013.
- 21. Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lescot et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit www.thelancet.com Published online June 14, 2018 http://dx.doi.org/10.1016/S0140-6736(18)31080-8
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Original Articles |
| Authors | |
| Project Number | yok |
| Publication Date | December 28, 2021 |
| Submission Date | October 2, 2021 |
| Acceptance Date | November 22, 2021 |
| Published in Issue | Year 2021 Volume: 3 Issue: 3 |
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