Document Detail

The acid-base effect of changing citrate solution for regional anticoagulation during continuous veno-venous hemofiltration.
MedLine Citation:
PMID:  18373316     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To compare the acid-base balance effects of two different citrate doses for regional citrate anticoagulant (RCA) for continuous veno-venous hemofiltration (CVVH). METHODS: We used a commercial citrate fluid (citrate concentration: 11 mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14 mmol/L) from July 2004 to Feb 2005 (Period B) in 21 patients. Replacement fluid rate was fixed at 2,000 ml/h. We measured all relevant variables for acid-base analysis according to the Stewart-Figge methodology. RESULTS: After commencement of RCA-CVVH, there was a change in bicarbonate and base excess (BE) toward acidosis for both fluids. This change was significantly different between period A and B at 6 and 12 hours (pH: p<0.01, BE: p<0.05) with greater decreases with the 11 mmol/L citrate fluid. These changes were mostly secondary to an increase in the strong ion difference (SID) and occurred despite an increased strong ion gap (SIG) (+0.5 mEq/L vs. +1.5 mEq/L; p<0.01) in the higher citrate concentration fluid. Cessation of RCA-CVVH was associated with short-lived differences in bicarbonate and SIG which were similar to those seen on initiation of RCA-CVVH but in the opposite direction. CONCLUSIONS: A small increase This was partly offset by an increase in SIG, consistent with increased citratemia. Cessation of treatment showed a differential improvement in SIG also consistent with disposal of therapy-associated citrate. These observations might assist clinicians in interpreting acidbase changes during citrate infusion rate caused an alkalinizing increase in SID.
M Egi; T Naka; R Bellomo; C C Langenberg; W Li; N Fealy; I Baldwin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The International journal of artificial organs     Volume:  31     ISSN:  0391-3988     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  228-36     Citation Subset:  IM    
Department of Intensive Care, University of Melbourne, Austin Hospital, Austin Health, Melbourne, Australia.
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MeSH Terms
Acid-Base Equilibrium / physiology*
Anticoagulants / administration & dosage*
Citric Acid / administration & dosage*
Critical Illness
Hemodialysis Solutions / administration & dosage*
Hemofiltration / methods*
Kidney Failure, Acute / therapy
Middle Aged
Reg. No./Substance:
0/Anticoagulants; 0/Hemodialysis Solutions; 77-92-9/Citric Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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