Use of an Osmotic Diuretic—THAM—in Treatment of Barbiturate Poisoning

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Abstract
Of the many methods employed to treat barbiturate poisoning, forced diuresis has been recommended by a few groups. Experimentally, the authors have found tromethamine (THAM), an osmotic diuretic and in vivo buffer, to be an excellent augmentor of renal elimination of pentobarbital (a short-acting barbiturate). They present a case of poisoning with phenobarbital (a long-acting barbiturate), in a 22-year-old woman, showing this same effect. The possible mechanisms of action are: (1) alkali nization of urine, which promotes ionization of barbiturate into a form not readily reabsorbed by the proximal tubules of the kidney; (2) increased renal elimination of electrolytes, which interferes with the reabsorption of barbiturates. Furthermore, alkalinization of blood promotes outward migration of undissociated barbiturate molecules from within the cell, thus possibly lightening depth of narcosis and increasing plasma concentration, and enabling the kidneys to eliminate more barbiturates.

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