Q: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) should be used with caution at least in which one condition?
Answer: Acute liver failure
RCA should be used with high caution whenever there is a suspicion of decrease clearance of citrate. One such commonly encountered situation in ICU is an acute liver failure when transaminases go into thousands. In ICU this is most commonly seen in shock liver. Inability of liver to metabolize citrate results in severe acidosis and a decrease in ionized calcium.
#nephrology
#hepatology
References:
1. Apsner R, Schwarzenhofer M, Derfler K, et al. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr 1997; 109:123.
2. Kramer L, Bauer E, Joukhadar C, et al. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med 2003; 31:2450.
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