Treatment of metabolic alkalosis during continuous renal replacement therapy with regional citrate anticoagulation.
The use of citrate as an anticoagulant in continuous renal replacement therapy is an effective method to achieve regional anticoagulation of the extracorporeal blood circuit and to avoid systemic anticoagulation. This allows bleeding complications to be reduced and filter life time to be prolonged. However, citrate enters the systemic circulation and is metabolized in the liver to bicarbonate, causing metabolic alkalosis in some patients. In this case report, we discuss therapeutic interventions to control the acid-base status and to restore normal pH during continuous citrate hemodialysis.
Kindgen-Milles
D
D
Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf , Germany.
Amman
J
J
Kleinekofort
W
W
Morgera
S
S
D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000471:Alkalosis / Q000139:chemically induced / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D001639:Bicarbonates / Q000097:blood; D002951:Citrates / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008099:Liver / Q000378:metabolism; D008297:Male; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013997:Time Factors
D000925:Anticoagulants; D001639:Bicarbonates; D002951:Citrates; D015312:Hemodialysis Solutions; C514290:trisodium citrate