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- #Citrate #Anticoagulation #Toxicity #toxicology #nephrology #diagnosis
