Abstract
To the Editor:— Concerning the paper by Dr. Manfredi et al . inThe Journal, July 2, on the basis of our personal experience, we cannot concur with some of the generalizations of the authors. Trihydroxymethylaminomethane (THAM) 1 (a weak base according to Bronsted's classification) owes its buffering activity in vivo to its property of proton acceptor; it will react with carbon dioxide only in solution according to the reaction:and with organic acids in a similar way:. It is now established that THAM depresses ventilation and increases carbon dioxide storage in the body. 2-4 Therefore, its use in severe respiratory acidosis should always be associated with effective artificially controlled respiration. The effectiveness of THAM in correcting acidosis in the first two cases reported by Manfredi is to be related to the combination of artificial ventilation and to the diuresis produced by this amine buffer.
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