Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration

BMC Nephrology

Research Article

Marc Diltoer¹  Patrick M. Honore¹  Herbert D. Spapen¹  Rita Jacobs¹ 

[1] Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium;

关键词: Citrate;    Anticoagulation;    Continuous veno-venous hemofiltration;    Acid-base balance;    Chloride;    Acidosis;    Alkalosis;    Hyperchloremic acidosis;    Strong ion gap;    Stewart-Figge approach;   

DOI  :  10.1186/s12882-016-0334-3

 received in 2016-02-02, accepted in 2016-08-17,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCitrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.MethodsThe effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). The next group was treated with Prismocitrate 18/0 (PC18; 18 mmol citrate/L). Both groups received bicarbonate-buffered fluids in post-dilution.ResultsAt similar citrate flow, the metabolic acidosis present at baseline in both groups was significantly attenuated in PC18 patients but persisted in PC10/2 patients after 24 h of treatment (median pH 7,42 vs 7,28; p = 0.0001). Acidosis in the PC10/2 group was associated with a decreased strong ion difference and an increased strong ion gap (respectively 43 vs. 51 mmol/L and 17 vs. 12 mmol/L, PC10/2 vs. PC18; both p = 0.001). Chloride flow was higher in PC10/2 than in PC18 subjects (25.9 vs 14.3 mmol/L blood; p < 0.05).ConclusionCorrection of acidosis was blunted in patients who received 10 mmol citrate/L as regional anticoagulation during CVVH. This could be explained by differences in chloride flow between the applied citrate solutions inducing hyperchloremic acidosis.

【 授权许可】

CC BY   
© The Author(s). 2016