Table 2 Differential diagnosis between citrate accumulation and other benign conditions
Citrate accumulation | Citrate net overload | Insufficient citrate load | |
|---|---|---|---|
Origin | Reduced capacity to metabolize citrate | Excessive citrate administration/buffer needs | Insufficient citrate administration/buffer needs |
Total Ca/iCa ratio | > 2.5 | Normal (≤ 2.5) | Normal (≤ 2.5) |
Metabolic acidosis/alkalosis | Acidosis | Alkalosis | Acidosis |
CaCl2 administration | ↑ (tendence to hypocalcemia) | Normal | Normal |
Severity (risk) | High (hypocalcemia) | Low | Low |
Frequency | Uncommon if excluding high-risk cases | Common | Uncommon |
Complexity of correction | Complex | Easy | Easy |
Possible interventions | ↓ QB and/or ↑ QD and/or ↑ QRpost ↓ target citrate dose (mmolCIT/LB) or RCA stopping with switch to alternative anticoagulation strategies | ↓ QB and/or ↑ QD and/or ↑ QRpost ↓ target citrate dose (mmolCIT/LB) | ↑ QB and/or ↓ QD and/or ↓ QRpost ↑ target citrate dose (mmolCIT/LB) |