Published in:
01-12-2019 | Acidosis | Case Report
Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit
Authors:
Anais Degraeve, Etienne Danse, Pierre-François Laterre, Philippe Hantson, Alexis Werion
Published in:
Journal of Artificial Organs
|
Issue 4/2019
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Abstract
Regional citrate anticoagulation is now widely used during continuous renal replacement therapy (CRRT), and especially in patients at risk for hemorrhagic complications. A close monitoring is required to avoid citrate overload, leading to metabolic alkalosis or citrate intoxication causing metabolic acidosis. This case report describes a dysfunction of the regional citrate anticoagulation due to the development of a deep vein thrombosis close to the site of insertion of the venous CRRT catheter. The result was a local recirculation in the circuit with a local citrate overload (acidosis and non-measurable calcium). In the patient’s blood samples, the [calciumtotal/Ca2+systemic] ratio remained normal as a proof of local citrate accumulation without systemic effects. Initially, CRRT remained effective, but due to the progressive decrease of serum creatinine and cystatin C clearance, the site of catheter insertion was changed.