Kindgen-Milles Detlef, Kram Rainer, Kleinekofort Wolfgang, Morgera Stanislao
University Hospital Düsseldorf, Department of Anaesthesiology, Heinrich Heine University, Düsseldorf, Germany.
ASAIO J. 2008 Jul-Aug;54(4):442-4. doi: 10.1097/MAT.0b013e31817dc3be.
We report a patient with severe hypercalcemia and acute kidney failure, in whom citrate anticoagulation was used not only for anticoagulation but also to correct ionized hypercalcemia (1.77 mmol/L). In this patient, after a complicated surgical procedure, septic shock led to acute kidney failure. We started continuous venovenous hemodialysis with citrate anticoagulation. By almost stopping the calcium substitution during the first hours, elevated systemic ionized calcium decreased into the normal range within 8 hours. Although calcium substitution was then increased, serum ionized calcium decreased to a nadir of 0.86 mmol/L and then stabilized within the normal range within the next 24 hours. To correct the imbalance in systemic ionized calcium concentration, the calcium substitution was varied over a wide range of 0.1-3.0 mmol/L of generated effluent. The time delay between adjustment in calcium infusion rate and the first detectable change in ionized calcium level was below 4 hours. However, the full response to a change of the calcium substitution was found after 8-12 hours.
我们报告了一位患有严重高钙血症和急性肾衰竭的患者，在该患者中，枸橼酸盐抗凝不仅用于抗凝，还用于纠正离子化高钙血症（1.77 mmol/L）。在该患者中，经历复杂的手术后，感染性休克导致了急性肾衰竭。我们开始采用枸橼酸盐抗凝进行连续性静脉-静脉血液透析。在最初几个小时几乎停止钙剂补充后，升高的全身离子化钙在8小时内降至正常范围。尽管随后增加了钙剂补充，但血清离子化钙降至最低点0.86 mmol/L，然后在接下来的24小时内稳定在正常范围内。为纠正全身离子化钙浓度的失衡，在所产生的流出液中，钙剂补充在0.1 - 3.0 mmol/L的广泛范围内变化。钙剂输注速率调整与离子化钙水平首次可检测到的变化之间的时间延迟低于4小时。然而，在8 - 12小时后发现对钙剂补充变化的完全反应。
