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Clinical Chemistry 43: 412-413, 1997;
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(Clinical Chemistry. 1999;43:412-413.)
© 1999 American Association for Clinical Chemistry, Inc.

Letters

Profound Hypercalcemia in Continuous Veno-Venous Hemofiltration Dialysis with Trisodium Citrate Anticoagulation and Hepatic Failure

Michael A. Nowaka and Tom E. Campbell

Western Reserve Care System, Dept. of Pathol. and Lab. Med., 500 Gypsy Lane, Youngstown, OH 44501
a author for correspondence.


To the Editor:

Continuous hemodialysis, either arteriovenous or veno-venous, is increasingly used in critically ill patients with acute renal failure. Trisodium citrate has become popular as a regional anticoagulant for these procedures to minimize the risk of hemorrhage and thrombocytopenia associated with heparin (1). Excess calcium citrate and citrate ions are removed by dialysis enhanced by calcium-free, alkali-free dialysate, thus requiring a CaCl2 infusion to maintain serum calcium. Noncritical hypocalcemia and metabolic alkalosis have been associated with such treatment (2).

We recently observed a patient who developed profound hypercalcemia while undergoing continuous veno-venous hemofiltration dialysis (CVVHD). This 76-year-old man had a long history of myasthenia gravis, non-insulin-dependent diabetes . . . [Full Text of this Article]


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