Table 5.
Solutions used with the postdilution continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA) Shock protocol
| Solute (mM) | ACDA Citrate, 113 mM | CKRT Fluid 1 NxStage RFP-403 2K/35Bic | CKRT Fluid 2 (Fluid 1 Spiked with 3M KHPO4) 4K/35Bic | 136 mM CaCl2 in 0.9% Saline |
| Calcium | 0 | 0 | 136 | |
| Magnesium | 0.75 | 0.75 | 0 | |
| Chloride | 108.5 | 108.5 | 395 | |
| Glucose | 124 | 5.5 | 5.5 | 0 |
| Sodium | 225 | 140 | 140 | 123 |
| Citric acid | 38 | |||
| Citrate3− | 75 | |||
| Potassium | 2 | 4 | ||
| Bicarbonate | 35 | 35 | ||
| Phosphate1.3− | 1.5 |
Ideally, CKRT Fluid 1 (NxStage RFP-403) and CKRT Fluid 2 could be used with the Shock protocol as these have 140 mM Na level (instead of 146) for the same 35 mM HCO3 level provided. CKRT fluid 1 can be spiked with K-phosphate or K-chloride or Na-phosphate to final K 2, 3, or 4 mM and phosphate 0, 2.1, or 4.2 mg/dl (0, 0.68, or 1.36 mM). The CKRT Fluid one or two glucose level of 5.5 mM ensures a mildly positive glucose balance on the CKRT circuit. The 136 mM calcium chloride solution was compounded in the hospital pharmacy by adding 125 ml of 10% CaCl2 (6.8 mmol Ca/10 ml) to 500 ml of 0.9% saline. Commercially available glucose-containing CKRT Fluid 1; 3M K-phosphate spiked CKRT Fluid 2 and compounded Ca infusion. ACDA, acid citrate dextrose anticoagulant; CKRT, continuous KRT.