Citrate Plasma Levels in Patients Under Regional Anticoagulation in Continuous Venovenous Hemofiltration

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

“…As previously discussed, alterations of ionized calcium levels may also occur as a consequence of accumulation of calcium-citrate complexes in patients with impaired citrate metabolism. In this situation, increasing levels of total serum calcium coexist with low systemic ionized calcium levels, leading to high-calcium ratio values (10,54). Metabolic acidosis may develop when impaired citrate metabolism prevents bicarbonate generation or, alternatively, from an insufficient buffer supply.…”

“…As a consequence, progressively higher calcium infusion rates may be required to maintain the ionized calcium concentration within physiologic limits, and there may be a disproportionate rise in both the total systemic calcium concentration and the total-to-ionized calcium ratio (the calcium ratio) (11,22,44,52). In clinical practice, because the calcium ratio is related to the blood citrate concentration, it is commonly accepted as an indirect index of citrate accumulation during RCA (45,48,(53)(54)(55). A calcium ratio.2.5 is considered the critical threshold for increased risk of metabolic complications caused by impaired citrate metabolism (54).…”

“…In clinical practice, because the calcium ratio is related to the blood citrate concentration, it is commonly accepted as an indirect index of citrate accumulation during RCA (45,48,(53)(54)(55). A calcium ratio.2.5 is considered the critical threshold for increased risk of metabolic complications caused by impaired citrate metabolism (54). However, it has been reported that a lower cutoff of 2.1 seems to accurately predict citrate overdose (systemic citrate concentration.1 mmol/L) with high sensitivity and specificity (89% and 100%, respectively) (55).…”

Efeito do extrato de Mikania glomerata Sprengel (guaco) sobre a implantação e o desenvolvimento embrinário e placentário em camundongos.

“…Estudos também têm mostrado que a cumarina apresenta atividade tóxica em fígados de ratos (BORN et al, 2000), atividade contraceptiva em ratas (ULUBEEN et al, 1994) e é responsável também pela Síndrome da Warfarina (HETZEL et al, 2006). Por outro lado o uso de agentes cumarínicos tem sido relacionado a malformações do tipo: microftalmia, retardo no crescimento ósseo, condrodisplasia puntacta, hipoplasia de membros, retardo mental, restrição de crescimento intra uterino, aborto espontâneo, natimortalidade e hemorragias (BRIGS; FREEMAN;YAFFE et al, 1994;HALL et al, 1980;HOWE et al, 1992;PAULI et al, 2010;O'REILLY, 1980).…”

“…(HALL et al, 1980;O'REILLY, 1980;HOWE et al, 1992;BRIGS et al, 1994;PAULI et al, 1999;HETZEL et al, 2006;ABRAHAM et al, 2010, MCLINTOCK, 2011 …”