ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
impairment, we studied plasma and
ultrafiltrate levels during continuous
veno-venous hemodiafiltration
(CVVHDF). Methods: A routine
determination of citrate in plasma and
dialysate using a modular analyser
(Architect c8, Abbott Italia) was set up
by adapting a commercial citrate lyase
method. This method was modified by
lowering the sample volume, with a
curve linear up to 4 mmol/L. Citrate
concentrations were measured undiluted
in systemic plasma (range .1-4 mmol/L)
and with 1:2 sample dilution in circuit
plasma or ultrafiltrate (range .2-8
mmol/L). In vitro we studied the
distribution of blood citrate between
intra- and extracellular compartments.
Ex vivo we studied citrate levels in
systemic and circuit plasma and in
ultrafiltrate (at , .5, 1, 3, 6, 9, 12, 24, 48
and 72 hrs) of 12 septic shock patients
with liver dysfunction on CVVHDF.
Results: In order to evaluate blood
distribution of citrate between intra- and
extracellular compartments, we found in
vitro a significant correlation (r .9997, y
= .66 + 1.2x, n 36) between the plasma
measured and the predicted citrate
concentrations for an exclusive
extracellular distribution (taking into
account the hematocrit value).
Ex vivo median systemic citrate levels
were .9 (.6-.12) mmol/L (time) and .23
(.18-.31) mmol/L during CVVHDF.
Median sieving coefficient for citrate
was .95 (.88-1.2), and did not change
with different blood flow (<strong>from</strong> 1 to 15
ml/min) and effluent volume (<strong>from</strong> 135
to 51 ml/hour). Net citrate removal by
filter significantly correlated with the
effluent volume (r .85). Median citrate
load entering in patient bloodstream was
as low as 13.6 (9.1-19.6, n 68)
mmol/hour. Citrate tests in systemic
blood increased daily cost of citrate
anticoagulation <strong>from</strong> 2.96 to 3.51 Euro.
However, due to longer filter survival
and reduced hemorrhagic complications
saving costs could be potentially
relevant if test availability allowed a
more extended use of citrate
anticoagulation. Conclusion: Kinetics
study demonstrated that citrate did not
accumulate in septic shock patients with
liver dysfunction, where citrate losses in
the ultrafiltrate can be efficiently
modulated by increasing the effluent
volume.
13. Fulminant wilson’s crisis:
plasmapharesis vs. Mars
Prince Mohan, Abdallah Geara, Richard
Kronfol, Jason Long, Jai
Radhakrishnan, Amay Parikh
Columbia University
Introduction: Wilson’s disease presents
with chronic hepatic and neurologic
dysfunction. In rare cases, it can present
with fulminant liver failure and multiple
organ dysfunction (including renal
failure, hemolytic anemia,
coagulopathy). Patients have blood high
levels of copper and the initial therapy of
fulminant Wilson’s crisis is directed at
decreasing copper levels. Since copper is
albumin bound, we evaluated 2
modalities of extra-corporeal copper
clearance: Molecular Adsorbant
Recirculating System (MARS) and
plasmapheresis. This case report will
explore the efficacy of copper clearance
utilizing both modalities. Methods:
A 25-year-old woman with known
Wilson’s disease on trientine
dihydrochloride presented with
fulminant Wilson’s crisis due to
medication noncompliance for the
previous 1 year (acute hemolytic anemia,
fulminant liver failure, acute kidney
injury). Both MARS and plasmapheresis
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