Calcium gluconate instead of calcium chloride in citrate-anticoagulated CVVHD
Oktay Demirkıran, Murat Eren Köşük, Süha Bozbay
İ.Ü.Cerrahpaşa Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, Yoğun Bakım Bilim Dalı, Acil Yoğun Bakım Ünitesi
INTRODUCTION: The Ci-Ca CVVHD is a successfully implemented protocol in several European countries to conduct CRRT in patients with AKI [1]. This protocol recommends a calcium chloride solution (CaCl-S) for calcium supplementation. Due to non-availability of CaCl-S, we modified this approach and used a calcium gluconate solution (CaGl-S) instead. METHODS: In 14 critically ill patients analysed retrospectively for the systemic ionized Ca (s-iCa)and acid-base parameters to ensure safe application of our modified protocol. The Ci-Ca CVVHD protocol [1] relies on modifying the calcium substitution to control s-iCa, which we applied analogously in our modified protocol. Further in the Ci-Ca CVVHD protocol, the ratio between dialysate and blood flow is linked to the effect on the acid-base status and typically set to 33%, which we essentially applied throughout the study using 3 l/h dialysate flow at 150 ml/min blood flow. RESULTS: With respect to systemic iCa, our patients group had low values at start of Ci-Ca CVVHD, which might already explain the higher required amount of CaGl-S compared to literature data assuming that a calcium deficit in the patients is filled up. Concerning acid-base results, we did see a slight tendency to alkalosis after prolonged Ci-Ca CVVHD with CaGl-S. This might well be attributed to gluconate metabolism yielding some additional bicarbonate. CONCLUSION: We successfully established use of a CaGl-S with the Ci-Ca CVVHD protocol. Noting the slight trend to alkalosis, we have decided to slightly to reduce the blood flow to 130 ml/min in. This will reduce citrate needs and less citrate will be metabolized by the patient to bicarbonate. 1 Slowinski et al. Crit Care 19:349
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