title: Lactic acidosis treated with continuous hemodiafiltration and regional citrate anticoagulation.
abstract: 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.
authors.affiliation: Department of Medicine, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298-0160.
authors.forename: B
authors.initials: B
authors.lastname: Kirschbaum
authors.forename: M
authors.initials: M
authors.lastname: Galishoff
authors.forename: H D
authors.initials: HD
authors.lastname: Reines
mesh_terms: 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
chemical_list: D001639:Bicarbonates; D002712:Chlorides; D002951:Citrates; D019343:Citric Acid; D017693:Sodium Bicarbonate; D012964:Sodium