Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

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...

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Bibliographic Details
Published in:	Journal of artificial organs Vol. 22; no. 4; pp. 341 - 344
Main Authors:	Degraeve, Anais, Danse, Etienne, Laterre, Pierre-François, Hantson, Philippe, Werion, Alexis
Format:	Journal Article
Language:	English
Published:	Tokyo Springer Japan 01-12-2019 Springer Nature B.V
Subjects:	Acidosis Acute Kidney Injury - blood Acute Kidney Injury - therapy Alkalosis Anticoagulants Anticoagulants - pharmacology Biomedical Engineering and Bioengineering Blood Coagulation - drug effects Calcium Calcium - metabolism Cardiac Surgery Case Report Catheters Circuits Citric acid Citric Acid - pharmacology Complications Continuous Renal Replacement Therapy - adverse effects Creatinine Cystatin C Female Hemorrhage Humans Iliac Vein Insertion Intoxication Liver Transplantation Medical instruments Medicine Medicine & Public Health Metabolic acidosis Metabolism Middle Aged Nephrology Regional development Thromboembolism Thrombosis Tomography, X-Ray Computed Ultrasonography, Doppler, Color Venous Thrombosis - diagnosis Venous Thrombosis - drug therapy Venous Thrombosis - etiology Regional citrate anticoagulation Recirculation Continuous renal replacement therapy
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Summary:	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 [calcium total /Ca 2+ 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.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1434-7229 1619-0904
DOI:	10.1007/s10047-019-01125-3