Lactic acidosis treated with continuous hemodiafiltration and regional citrate anticoagulation.
OBJECTIVE
To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure.


METHODS
Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.


METHODS
University hospital ICU.


METHODS
Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.


METHODS
CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.


METHODS
Total and ionized serum calcium concentrations and citrate concentrations were monitored.


RESULTS
CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.


CONCLUSIONS
CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.
Kirschbaum
B
B
Department of Medicine, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298-0160.
Galishoff
M
M
Reines
H D
HD
D000140:Acidosis, Lactic / Q000150:complications / Q000628:therapy*; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000009:adverse effects; D002712:Chlorides / Q000097:blood; D002951:Citrates / Q000008:administration & dosage* / Q000097:blood; D019343:Citric Acid; D005260:Female; D006440:Hemofiltration; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000009:adverse effects; D017693:Sodium Bicarbonate
D001639:Bicarbonates; D002712:Chlorides; D002951:Citrates; D019343:Citric Acid; D017693:Sodium Bicarbonate; D012964:Sodium