Table 7 Pathogenesis and management of RCA-related metabolic complications
Item | Citrate accumulation | Alkali overload (including citrate overload) | Insufficient base delivery |
|---|---|---|---|
Mechanism | CCC metabolism is inhibited and CCC persists in the systemic circulation | CCC metabolism is normal, alkali load exceeds demand | CCC metabolism is normal, alkali load cannot meet demand |
Acidosis or alkalosis | Metabolic acidosis | Metabolic alkalosis | Metabolic acidosis |
Total-Ca/iCa | Increased (≥ 2.5) | Normal (< 2.5) | Normal (< 2.5) |
iCa | Decreased | No change | No change |
Calcium supplement | Increased | No change | No change |
Consequences | Potentially lethal | Benign, easy to correct | Benign, easy to correct |
Incidence rate | Rare | Common | Infrequent |
Management | Manage the cause, or reduce citrate infusion rate, or consider other anticoagulant strategies | Reduce additional alkali, or increase the flow rate of replacement fluid or dialysate, or reduce citrate infusion rate | Add additional alkali, or decrease the flow rate of replacement fluid or dialysate, or increase citrate infusion rate |