A 65-year-old woman on ICU is receiving CVVHDF with regional citrate anticoagulation. The ICU nurse notes that the post-filter ionised calcium is 0.45...

Question

A 65-year-old woman on ICU is receiving CVVHDF with regional citrate anticoagulation. The ICU nurse notes that the post-filter ionised calcium is 0.45 mmol/L (target 0.25-0.35 mmol/L) and the systemic ionised calcium is 1.18 mmol/L (normal 1.15-1.30 mmol/L). What adjustment is required?

Accepted Answer

Increase the citrate infusion rate to lower the post-filter ionised calcium

Answer

Decrease the calcium replacement infusion

Answer

No adjustment needed - systemic calcium is normal

Answer

Stop the citrate and switch to heparin anticoagulation

Answer

Increase the blood flow rate

uk-fficm MCQ (SBA): Citrate Anticoagulation

A 65-year-old woman on ICU is receiving CVVHDF with regional citrate anticoagulation. The ICU nurse notes that the post-filter ionised calcium is 0.45 mmol/L (target 0.25-0.35 mmol/L) and the systemic ionised calcium is 1.18 mmol/L (normal 1.15-1.30 mmol/L). What adjustment is required?