Critical care medicine · 1992
Lactic acidosis treated with continuous hemodiafiltration and regional citrate anticoagulation.
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Kirschbaum B, Galishoff M, Reines H D
Аннотация
OBJECTIVE: To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure.
DESIGN: Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.
SETTING: University hospital ICU.
PATIENTS: Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.
INTERVENTIONS: CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.
MEASUREMENTS: Total and ionized serum calcium concentrations and citrate concentrations were monitored.
MAIN RESULTS: CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.
CONCLUSIONS: CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.
DESIGN: Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.
SETTING: University hospital ICU.
PATIENTS: Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.
INTERVENTIONS: CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.
MEASUREMENTS: Total and ionized serum calcium concentrations and citrate concentrations were monitored.
MAIN RESULTS: CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.
CONCLUSIONS: CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.