Citrate anticoagulation and adverse events.
Several patients with heparin intolerance were dialysed with tri-sodium citrate as anticoagulant without acute clinical problems (good tolerance). After some weeks however problems arose. In all patients an alkalosis developed: the pre dialysis bicarbonate level rose progressively from 27 mmol/l to 40 mmol/l. This could be tempered by lowering the dialysis fluid bicarbonate concentration from 37 mmol/l to 25 mmol/l. A second problem was a progressive rise in pre dialysis sodium level from a mean of 136 mmol/l to 150 mmol/l. Adapting the dialysis fluid sodium concentration from 140 mmol/l towards 132 mmol/l could solve this. The third problem was a progressive rise in serum aluminium level in patients from 3 microg/l to 38 microg/l. After excluding water, concentrate, dialysis fluid, drug intake, etc... as possible sources, we controlled the aluminium level in the glass bottle containing tri-sodium citrate. We noted the very high value of 35,300 microg/l. After replacing the glass bottles with polyvinylchloride bags with a negligible aluminium content, the serum aluminium levels returned back to normal. It is known that citrate chelates the aluminium present in the glass of bottles or vials.
De Vos
J
J
AZ Werken Glorieux, Hogerlucht 6, 9600 Ronse, Belgium. devosjy@skynet.be
Hombrouckx
R
R
D000471:Alkalosis / Q000097:blood / Q000139:chemically induced*; D000535:Aluminum / Q000032:analysis / Q000097:blood*; D000925:Anticoagulants / Q000009:adverse effects*; D001639:Bicarbonates / Q000032:analysis / Q000097:blood; D002951:Citrates / Q000009:adverse effects*; D005898:Glass / Q000737:chemistry; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000139:chemically induced*; D018579:Patient Selection; D011145:Polyvinyls / Q000737:chemistry; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors; D012964:Sodium / Q000032:analysis; D000077559:Sodium Citrate; D016896:Treatment Outcome
D000925:Anticoagulants; D001639:Bicarbonates; D002951:Citrates; D015312:Hemodialysis Solutions; D011145:Polyvinyls; D000077559:Sodium Citrate; D012964:Sodium; D000535:Aluminum