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10.1093/ckj/sfs045 http://scihub22266oqcxt.onion/10.1093/ckj/sfs045 C4400517!4400517 !26069766     free     free     free Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\26069766 .jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117       Clin+Kidney+J 2012 ; 5 (3 ): 212-6 Nephropedia Template TP {{tp|p=26069766 |t=2012. Regional citrate anticoagulation for slow continuous ultrafiltration: risk of severe metabolic alkalosis |pdf=|usr=}}{{26069766 }} gab.com Text Regional citrate anticoagulation for slow continuous ultrafiltration: risk of severe metabolic alkalosis JO: Clin Kidney J http://www.kidney.de/pget.php?&tw=1&pmid=26069766 #FOAvip BACKGROUND: Slow continuous ultrafiltration (SCUF) is a safe and efficient treatment for fluid overload in patients who are hemodynamically unstable, have low urine output, and are not in need of dialysis or hemofiltration for solute clearance. Sustained anticoagulation is required for these long treatments, thus posing clinically challenges for patients having contraindications to systemic anticoagulation with heparin. Regional citrate anticoagulation would be an alternative option; however, we believed that this would be problematic due to citrate kinetics that predicted the development of metabolic alkalosis. METHODS: In that patients' serum bicarbonate reached 45 mEq/L and arterial pH rose to 7.59 after just 3 days of SCUF, we developed equations to study this phenomenon. We report here the acid-base balance calculations quantifying base accumulation in SCUF compared to continuous venovenous hemofiltration (CVVH). RESULTS: This kinetic approach demonstrates the importance of accounting for the high citrate clearance into CVVH hemofiltrate, which prevents development of the alkalosis seen with the relatively low ultrafiltration rates in SCUF: there was net bicarbonate accumulation of ?1400 mmol/day with SCUF, compared to 664 to as low as 274 mmol/day during CVVH. The calculations underscore the importance of the relative fluid flow rates as well as the bicarbonate and citrate levels in the various infused solutions. We also discuss how citrate's acid-base effects are potentially complicated by metabolism via gluconeogenic and ketone body pathways. CONCLUSIONS: These acid-base balance findings emphasize why clinicians must be mindful of the risk of metabolic alkalosis when using continuous renal replacement therapy modalities with low rates of ultrafiltration, which thereby presents a contraindication for using citrate anticoagulation for SCUF. Twit Text FOAVip Regional citrate anticoagulation for slow continuous ultrafiltration: risk of severe metabolic alkalosis ????Clin Kidney J http://www.kidney.de/pget.php?&tw=1&pmid=26069766 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=26069766 #FOAvip English Wikipedia <ref>{{Cite pmid|26069766 }}</ref> Regional citrate anticoagulation for slow continuous ultrafiltration: risk of severe metabolic alkalosis #MMPMID26069766 Alsabbagh MM ; Ejaz AA ; Purich DL ; Ross EA Clin Kidney J 2012[Jun]; 5 (3 ): 212-6 PMID26069766 show ga BACKGROUND: Slow continuous ultrafiltration (SCUF) is a safe and efficient treatment for fluid overload in patients who are hemodynamically unstable, have low urine output, and are not in need of dialysis or hemofiltration for solute clearance. Sustained anticoagulation is required for these long treatments, thus posing clinically challenges for patients having contraindications to systemic anticoagulation with heparin. Regional citrate anticoagulation would be an alternative option; however, we believed that this would be problematic due to citrate kinetics that predicted the development of metabolic alkalosis. METHODS: In that patients' serum bicarbonate reached 45 mEq/L and arterial pH rose to 7.59 after just 3 days of SCUF, we developed equations to study this phenomenon. We report here the acid-base balance calculations quantifying base accumulation in SCUF compared to continuous venovenous hemofiltration (CVVH). RESULTS: This kinetic approach demonstrates the importance of accounting for the high citrate clearance into CVVH hemofiltrate, which prevents development of the alkalosis seen with the relatively low ultrafiltration rates in SCUF: there was net bicarbonate accumulation of ?1400 mmol/day with SCUF, compared to 664 to as low as 274 mmol/day during CVVH. The calculations underscore the importance of the relative fluid flow rates as well as the bicarbonate and citrate levels in the various infused solutions. We also discuss how citrate's acid-base effects are potentially complicated by metabolism via gluconeogenic and ketone body pathways. CONCLUSIONS: These acid-base balance findings emphasize why clinicians must be mindful of the risk of metabolic alkalosis when using continuous renal replacement therapy modalities with low rates of ultrafiltration, which thereby presents a contraindication for using citrate anticoagulation for SCUF. äRegional citrate anticoagulation for slow continuous ultrafiltration: (epmc).pdf DeepDyve Pubget Overpricing