Q: During continuous renal replacement therapy (CRRT) what's the best way to assesses that the excessive citrate is given and regional citrate anticoagulation (RCA) may need to be stopped?
Answer: A ratio of total calcium to ionized calcium >2.5
Other ways to suspect excessive citrate during CRRT were worsening metabolic acidosis, increasing anion gap, decreasing ionized calcium or higher requirement of calcium infusion rates.
#nephrology
References:
1. Meier-Kriesche HU, Gitomer J, Finkel K, DuBose T. Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation. Crit Care Med 2001; 29:748.
2. Bakker AJ, Boerma EC, Keidel H, et al. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium. Clin Chem Lab Med 2006; 44:962.
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