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Title: The acid-base effect of changing citrate solution for regional anticoagulation during continuous veno-venous hemofiltration.
Austin Authors: Egi, Moritoki;Naka, Toshio;Bellomo, Rinaldo ;Langenberg, Christoph;Li, W;Fealy, Nigel G ;Baldwin, Ian C 
Affiliation: Department of Intensive Care, University of Melbourne, Austin Hospital, Austin Health, Melbourne, Australia
Issue Date: 1-Mar-2008
Publication information: The International Journal of Artificial Organs; 31(3): 228-36
Abstract: To compare the acid-base balance effects of two different citrate doses for regional citrate anticoagulant (RCA) for continuous veno-venous hemofiltration (CVVH).We used a commercial citrate fluid (citrate concentration: 11 mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14 mmol/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.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.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 acidbase changes during citrate infusion rate caused an alkalinizing increase in SID.
Gov't Doc #: 18373316
Type: Journal Article
Subjects: Acid-Base Equilibrium.physiology
Acute Kidney Injury.therapy
Anticoagulants.administration & dosage
Citric Acid.administration & dosage
Critical Illness
Hemodialysis Solutions.administration & dosage
Middle Aged
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