Clinical Presentation & Protocol
Patient Usually Complains Of
Patient currently undergoing CRRT with regional citrate anticoagulation (RCA) presents with clinical signs suggestive of citrate toxicity. Symptoms include circumoral paresthesia, muscle cramps, and altered mental status. Recent labs indicate a widening total-to-ionized calcium ratio (>2.5), metabolic acidosis, and refractory hypocalcemia despite calcium supplementation.
Clinical Examination Findings
Patient appears distressed with positive Chvostek’s and Trousseau’s signs. Neurological assessment reveals hyperreflexia and potential tetany. Hemodynamic status is unstable, potentially secondary to myocardial depression from profound hypocalcemia.
Treatment Protocol
Immediate cessation of citrate infusion. Initiate calcium gluconate or calcium chloride replacement therapy. Increase CRRT blood flow or switch to heparin-based anticoagulation if clinically indicated. Monitor ionized calcium levels every 1-2 hours until stabilization.