From: Clinical review: Patency of the circuit in continuous renal replacement therapy
Derangement | Cause and signs | Adjustment |
---|---|---|
Metabolic acidosis | Insufficient removal of metabolic acids | Increase continuous renal replacement therapy dose |
Anion gap increases | (filtrate or dialysate flow) to 35 ml/kg per hour | |
Loss of buffer substrate is higher than delivery |
Increase bicarbonate replacement or increase bicarbonate dialysate flow or give additional bicarbonate or increase citrate flow (cave accumulation) | |
Citrate metabolism decreases (iCa decreases, totCa/iCa increases [more than 2.1–2.5], and anion gap increases) |
Decrease citrate delivery or stop increase dialysate or filtrate flow increase bicarbonate replacement or increase bicarbonate dialysate flow | |
Metabolic alkalosis | Delivery of buffer substrate is higher than loss |
Decrease bicarbonate replacement or decrease bicarbonate dialysate flow or stop additional bicarbonate i.v. or decrease citrate flow (cave anticoagulation) |
Decreased loss of buffer due to a decline in filtrate flow |
Change filter Increase filtrate flow | |
Hypocalcemia | Loss of calcium is higher than delivery (iCa decreases and totCa/iCa is normal) | Increase i.v. calcium dose |
Citrate metabolism decreases (metabolic acidosis, totCa/iCa increases, and anion gap increases) |
Increase i.v. calcium dose, decrease or stop citrate delivery increase dialysate or filtrate flow, increase bicarbonate replacement or increase bicarbonate dialysate flow | |
Hypercalcemia | Delivery of calcium is higher than loss | Decrease i.v. calcium dose |
Hypernatremia | Delivery of sodium is higher than loss | Recalculate default settings |
Protocol violation | ||
• decrease sodium replacement | ||
• decrease dialysate sodium content | ||
• decrease trisodium citrate flow | ||
Decreased loss of sodium due to a decline in filtrate flow | Change filter | |
Hyponatremia | Loss of sodium is higher than delivery | Recalculate default settings |
Protocol violation | ||
• increase sodium replacement | ||
• increase dialysate sodium content | ||
• increase trisodium citrate flow |