title: Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration.
abstract: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.
  
  
  
  The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). The next group was treated with Prismocitrate 18/0 (PC18; 18 mmol citrate/L). Both groups received bicarbonate-buffered fluids in post-dilution.
  
  
  
  At similar citrate flow, the metabolic acidosis present at baseline in both groups was significantly attenuated in PC18 patients but persisted in PC10/2 patients after 24 h of treatment (median pH 7,42 vs 7,28; p = 0.0001). Acidosis in the PC10/2 group was associated with a decreased strong ion difference and an increased strong ion gap (respectively 43 vs. 51 mmol/L and 17 vs. 12 mmol/L, PC10/2 vs. PC18; both p = 0.001). Chloride flow was higher in PC10/2 than in PC18 subjects (25.9 vs 14.3 mmol/L blood; p < 0.05).
  
  
  
  Correction of acidosis was blunted in patients who received 10 mmol citrate/L as regional anticoagulation during CVVH. This could be explained by differences in chloride flow between the applied citrate solutions inducing hyperchloremic acidosis.
authors: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
authors: Rita
authors: R
authors: Jacobs
authors: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium. Patrick.Honore@az.vub.ac.be.
authors: Patrick M
authors: PM
authors: Honore
authors: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
authors: Marc
authors: M
authors: Diltoer
authors: Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
authors: Herbert D
authors: HD
authors: Spapen
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000138:Acidosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D058186:Acute Kidney Injury / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000737:chemistry*; D001639:Bicarbonates / Q000627:therapeutic use; D002021:Buffers; D002712:Chlorides / Q000032:analysis*; D019343:Citric Acid / Q000009:adverse effects*; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D001639:Bicarbonates; D002021:Buffers; D002712:Chlorides; D019343:Citric Acid
keywords: Acid-base balance; Acidosis; Alkalosis; Anticoagulation; Chloride; Citrate; Continuous veno-venous hemofiltration; Hyperchloremic acidosis; Stewart-Figge approach; Strong ion gap