title: Citrate pathophysiology and metabolism.
abstract: By chelating ionized calcium, citrate allows extracorporeal circuit anticoagulation without a bleeding risk for the patient. Citrate anticoagulation is also associated with a reduced activation of leucocytes and platelets. Citrate clearance by citric acid cycle (Krebs cycle) is not modified by renal failure, but is reduced by about 50% in patients with cirrhosis. Toxic effects of citrate result from a decrease in plasma ionized calcium of the patient. The first side effect is a prolongation of the QT interval. Clinical signs of hypocalcemia and hypotension in humans appear below 0.9mmol/L of plasma ionized calcium.
authors.affiliation: Intensive care deparment, Centre Hospitalier de Melun, Melun, F-77000, France. Electronic address: mn.monchi@gmail.com.
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000502:physiology*; D019343:Citric Acid / Q000378:metabolism*; D006801:Humans
chemical_list: D000925:Anticoagulants; D019343:Citric Acid
keywords: Anticoagulation; Citrate; Extra corporeal circuits; Pharmacodynamics; Toxicity