Lactic acidosis treated with continuous hemodiafiltration and regional citrate anticoagulation

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Abstract
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. Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU. University hospital ICU. Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings. CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit. Total and ionized serum calcium concentrations and citrate concentrations were monitored. 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. CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.

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