Total-to-ionized calcium ratio, taken alone, is no longer valid to diagnose citrate accumulation! What additional parameters should we consider to strengthen the utility of this ratio?

Besides being a marker of liver function, lactate is also a marker of anaerobic metabolism. Clinical suspicion for citrate accumulation in continuous veno-venous hemofiltration (CVVH) with RCA remains paramount but the interpretation of the T/iCa ratio should take these complex interactions into acc...

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Bibliographic Details
Published in:Journal of critical care 2020-10, Vol.59, p.172-175
Main Authors: Honore, Patrick M., Rimmelé, Thomas
Format: Article
Language:English
Subjects:
Acidosis
Acids
Adenosine triphosphate
Anticoagulants
Calcium
Citrates
Citric Acid
Critical care
Humans
Hypotension
Hypotheses
Liver
Medical diagnosis
Metabolism
Muscle function
Patients
Retrospective Studies
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Summary:Besides being a marker of liver function, lactate is also a marker of anaerobic metabolism. Clinical suspicion for citrate accumulation in continuous veno-venous hemofiltration (CVVH) with RCA remains paramount but the interpretation of the T/iCa ratio should take these complex interactions into account [1] and this might be cumbersome in practice. [...]ideally, we should use T/iCa ratio in conjunction with something else.3 The “Khadzhynov approach” In a recent meta-analysis, Zhang et al. concluded that RCA appears to be a safe anticoagulation method in liver failure patients undergoing CRRT [17]. Gluconeogenesis consumes ATP in the liver. [...]the metabolic burden is moved from exercising muscle to liver and the cycle stops once ATP is depleted (i.e. under anaerobic conditions). Disturbed microcirculation results in elevated lactate due to impaired organic substrate metabolism. [...]lactate is a marker for impaired citrate metabolism, a concept supported by Khadzhynov et al.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2020.06.009