Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulationReportar como inadecuado

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Critical Care

, 19:321

First Online: 08 September 2015Received: 30 April 2015Accepted: 13 August 2015


IntroductionIonized calcium iCa concentration is often used in critical care and measured using blood gas analyzers at the point of care. Controlling and adjusting regional citrate anticoagulation RCA for continuous renal replacement therapy CRRT involves measuring the iCa concentration in two samples: systemic with physiological iCa concentrations and post filter samples with very low iCa concentrations. However, modern blood gas analyzers are optimized for physiological iCa concentrations which might make them less suitable for measuring low iCa in blood with a high concentration of citrate. We present results of iCa measurements from six different blood gas analyzers and the impact on clinical decisions based on the recommendations of the dialysis’ device manufacturer.

MethodThe iCa concentrations of systemic and post filter samples were measured using six distinct, frequently used blood gas analyzers. We obtained iCa results of 74 systemic and 84 post filter samples from patients undergoing RCA for CRRT at the University Medicine of Greifswald.

ResultsThe systemic samples showed concordant results on all analyzers with median iCa concentrations ranging from 1.07 to 1.16 mmol-L. The medians of iCa concentrations for post filter samples ranged from 0.21 to 0.50 mmol-L. Results of >70 % of the post filter samples would lead to major differences in decisions regarding citrate flow depending on the instrument used.

ConclusionMeasurements of iCa in post filter samples may give misleading information in monitoring the RCA. Recommendations of the dialysis manufacturer need to be revised. Meanwhile, little weight should be given to post filter iCa. Reference methods for low iCa in whole blood containing citrate should be established.

AbbreviationsCRRTcontinuous renal replacement therapy

iCaionized calcium

IQCinternal quality control

POCTpoint of care testing

RCAregional citrate anticoagulation

Rili-BAEKGuideline of the German Medical Association on Quality Assurance in Medical Laboratory Examinations

A comment to this article is available at http:-dx.doi.org-10.1186-s13054-015-1148-6.

A comment to this article is available at http:-dx.doi.org-10.1186-s13054-015-1143-y.

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Autor: Patrik Schwarzer - Sven-Olaf Kuhn - Sylvia Stracke - Matthias Gründling - Stephan Knigge - Sixten Selleng - Maximilian Hel

Fuente: https://link.springer.com/

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