Department of Medicine, Division of Endocrinology, Gerontology and Metabolism, Stanford University, Stanford, CA, 94305, USA.
Department of Medicine, Division of Nephrology, Stanford University, Stanford, CA, 94305, USA.
Arch Osteoporos. 2024 Aug 24;19(1):78. doi: 10.1007/s11657-024-01434-y.
Awareness of the causes of hypercalcemia is essential for timely diagnosis of calcium disorders and optimal treatment. Citrate is commonly used as an anticoagulant during continuous renal replacement therapy (CRRT). Accumulation of citrate in the systemic circulation during CRRT may induce several metabolic disturbances, including total hypercalcemia and ionized hypocalcemia. The aim of the present study is to increase awareness of citrate accumulation and toxicity as a cause of hypercalcemia by relating three cases and reviewing the pathophysiology and clinical implications.
We utilized electronic health records to examine the clinical cases and outlined key studies to review the consequences of citrate toxicity and general approaches to management.
Citrate toxicity is associated with high mortality. A safe threshold for tolerating hypercalcemia during citrate anticoagulation is not clearly defined, and whether citrate toxicity independently increases mortality has not been resolved. Greater attention to citrate toxicity as a cause of hypercalcemia may lead to earlier detection, help to optimize the management of systemic calcium levels, and foster interest in future clinical studies.
了解高钙血症的原因对于及时诊断钙代谢紊乱和优化治疗至关重要。柠檬酸盐通常在连续肾脏替代治疗 (CRRT) 中用作抗凝剂。在 CRRT 期间，柠檬酸盐在全身循环中的积累可能会引起多种代谢紊乱，包括总高钙血症和离子低钙血症。本研究旨在通过介绍三例病例并复习其病理生理学和临床意义，提高对柠檬酸盐蓄积和毒性引起高钙血症的认识。
我们利用电子病历检查了临床病例，并概述了关键研究，以复习柠檬酸盐毒性的后果和一般处理方法。
柠檬酸盐毒性与高死亡率相关。在柠檬酸盐抗凝期间耐受高钙血症的安全阈值尚未明确界定，并且柠檬酸盐毒性是否独立增加死亡率尚未解决。更多地关注柠檬酸盐毒性作为高钙血症的原因可能会导致更早的检测，有助于优化全身钙水平的管理，并激发对未来临床研究的兴趣。
