Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium
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Andries J. Bakker
Abstract
Background: The objective of this study was to elucidate the most practical and effective laboratory measurement for monitoring citrate in critically ill patients undergoing citrate-anticoagulated continuous venovenous haemofiltration (CVVH).
Methods: This observational study was performed at the mixed medical and surgical intensive care unit of a regional teaching hospital. The study population comprised ten consecutive critically ill patients with acute renal failure and indication for haemofiltration with the use of regional anticoagulation with citrate. Serum samples for the measurement of citrate and total and ionised calcium were taken from the pre- and post-filter compartments and from the arterial circulation of patients during citrate-anticoagulated CVVH.
Results: Receiver operating characteristic (ROC) curve analysis showed that for detecting citrate overdose (defined as a citrate concentration >1.0mmol/L) the best cut-off limits for total/ionised calcium and ionised calcium were 2.1 and 0.8mmol/L, respectively. Sensitivity and specificity for the cut-off limit of 2.1 for total/ionised calcium were 89% and 100%, and 84% and 100%, respectively, for the cut-off limit of 0.8mmol/L for ionised calcium.
Conclusions: In patients without liver insufficiency, total/ionised calcium performed slightly better than ionised calcium in detecting elevated citrate concentrations. However, because of the simplicity of its measurement, ionised calcium is preferred. Measurement of citrate is not necessary.
Clin Chem Lab Med 2006;44:962–6.
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©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
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Articles in the same Issue
- Laboratory medicine in the 2000s: programmed death or rebirth?
- Polymorphisms of the inflammatory system and risk of ischemic cerebrovascular events
- Haptoglobin polymorphism in patients with preeclampsia
- Fifteen polymorphisms in endothelin-1, endothelin-2 and endothelin-receptor-A genotyped by four duplex assays and seven simple assays on a LightCycler using hybridization probes
- Optimization of an enzymatic method for the determination of lysosomal N-acetyl-β-D-hexosaminidase and β-glucuronidase in synovial fluid
- An improved laboratory protocol to assess subarachnoid haemorrhage in patients with negative cranial CT scan
- Association of aminothiols with the clinical outcome in hemodialysis patients: comparison of chromatography and immunoassay for homocysteine determination
- Poor prognosis indicated by nucleated red blood cells in peripheral blood is not associated with organ failure of the liver or kidney
- Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium
- Unchanged androgen-binding properties of sex hormone-binding globulin in male patients with liver cirrhosis
- Relationship between serum uric acid, creatinine, albumin and gestational diabetes mellitus
- Aminothiols in human brain tumors
- Measurement of carnitine in hemodialysis patients – adaptation of an enzymatic photometric method for an automatic analyzer
- A robust liquid chromatography tandem mass spectrometry method for total plasma homocysteine determination in clinical practice
- Establishment of reference distributions and decision values for thyroid antibodies against thyroid peroxidase (TPOAb), thyroglobulin (TgAb) and the thyrotropin receptor (TRAb)
- Effects of a long-distance run on cardiac markers in healthy athletes
- α-Tocopherol supplementation reduces the elevated 8-hydroxy-2-deoxyguanosine blood levels induced by training in basketball players
- Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing
- The ratio of apoB/apoAI, apoB and lipoprotein(a) are the best predictors of stable coronary artery disease
- Evaluation of the analytical performance of the advanced method for cardiac troponin I for the AxSYM platform: comparison with the old method and the Access system
- Preliminary performance evaluation of blood gas analyzers
- A cost-effectiveness evaluation of reticulocyte measurement in new outpatients with or without hematologic disorders
- Guidelines for setting up an External Quality Assessment Scheme for blood smear interpretation. Part II: survey preparation, statistical evaluation and reporting
- Free light chain testing in follow-up of multiple myeloma
- Blood reactive oxygen metabolites (ROMs) and total antioxidant status (TAS) in patients with laryngeal squamous cell carcinoma after surgical treatment
- SIBioC 2006 38th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology, Turin, Italy, September 19–22, 2006
- Third Santorini Biologie Prospective Conference 2006: From Human Genetic Variations to Prediction of Risks and Responses to Drugs and the Environment, Santorini Island, Greece, September 29 - October 2, 2006
