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The acid-base effect of changing citrate solution for regional anticoagulation during continuous veno-venous hemofiltration

journal contribution
posted on 2008-01-01, 00:00 authored by M Egi, T Naka, R Bellomo, C Langenberg, W Li, N Fealy, Ian BaldwinIan Baldwin
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: 11mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14mmol/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 acid-base changes during RCA-CVVH.in citrate infusion rate caused an alkalinizing increase in SID.

History

Journal

International Journal of Artificial Organs

Volume

31

Pagination

228-236

Location

United States

ISSN

0391-3988

eISSN

1724-6040

Language

en

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

3

Publisher

SAGE Publications