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Crit Care. 2017 Nov 19;21(1):281. doi: 10.1186/s13054-017-1880-1.

Complications of regional citrate anticoagulation: accumulation or overload?

Author information

1
Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46 avenue du Bugnon, 1011, Lausanne, Switzerland. antoine.schneider@chuv.ch.
2
Université de Lausanne, UNIL, Lausanne, Switzerland. antoine.schneider@chuv.ch.
3
Anesthesiology and Intensive Care Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, René Descartes University, Paris, France.
4
Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
5
EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-induced Immunosupression - PI3", Joint Research Unit, Edouard Herriot Hospital, Lyon, France.

Abstract

Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside. In particular, the authors wish to propose a clear distinction between citrate accumulation and net citrate overload.

KEYWORDS:

Acute kidney injury; Citrate accumulation; Complications of therapy; Continuous renal replacement therapy; Metabolic alkalosis; Regional citrate anticoagulation

PMID:
29151020
PMCID:
PMC5694623
DOI:
10.1186/s13054-017-1880-1
[Indexed for MEDLINE]
Free PMC Article

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