Citrate Anticoagulation Toxicity

Hypernatremia (HyperNa):

Citrate Anticoagulation Toxicity

Hypernatremia (HyperNa):
 - Citrate solutions may have ↑ sodium content and should be paired with a lower sodium dialysate/replacement fluid
Hypomagnesemia (HypoMg):
 - Citrate binds Mg: this complex is removed via CKRT from circulation → ↓Mg
Hypocalcemia (HypoCa):
 - Citrate can bind free, ionized Ca (iCa)
 - If the [Total Ca: iCa] Ratio is > 2.5: think citrate toxicity
 - Remember to convert the units: Multiply the Total Ca (mg/dL) by 0.25 to convert to mmol/L
Anion-Gap Metabolic Acidosis:
 - Citrate is a weak, "unmeasured" anion
 - Liver dysfunction or low mean arterial pressure may increase citrate accumulation by impairing citrate metabolism
Metabolic alkalosis:
 - Bicarbonate may accumulate as:
 - 1 Citrate → 3 HCO3-

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