• Crit Care · Nov 2017

    Complications of regional citrate anticoagulation: accumulation or overload?

    • Antoine G Schneider, Didier Journois, and Thomas Rimmelé.
    • Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46 avenue du Bugnon, 1011, Lausanne, Switzerland. antoine.schneider@chuv.ch.
    • Crit Care. 2017 Nov 19; 21 (1): 281.

    AbstractRegional 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.

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