CRRT and magnesium

Q: Use of Regional citrate anticoagulation in Continuous Renal Replacement Therapy (CRRT) will cause? - Select one

A) hypermagnesemia

B) hypomagnesemia

Answer: B

Regional citrate anticoagulation should be considered a major intervention in all patients requiring CRRT, as it may cause alkalosis due to citrate. The concentration of buffers, i.e.,  bicarbonate and lactate, should be reduced. Also, citrate can bind magnesium. Dialysate magnesium should be raised to 0.75 mmol/L from 0.5 mmol/L.

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References:

1. DePriest J, Dodson C, Phelps B. The Impact of Regional Citrate Anticoagulation on Magnesium Replacement During CRRT. Hosp Pharm 2023; 58:255.

2. Billiet N, Merckx L, van der Laenen M, Vanelderen P, Boer W. Magnesium profiles in renal replacement therapy (rrt) on icu: citrate CVVH (CICVVH) vs. intermittent haemodialysis (IHD). Intensive Care Med Exp. 2015 Oct 1;3(Suppl 1):A630. doi: 10.1186/2197-425X-3-S1-A630. PMCID: PMC4796953.