Abstract P-102: METABOLIC DISTURBANCES IN CRITICALLY ILL CHILDREN UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPY WITH REGIONAL CITRATE ANTICOAGULATION.

Aims & Objectives: Regional citrate anticoagulation (RCA) is the preferred method of anticoagulation for continuous renal replacement therapy (CRRT) as it prolonges circuit lifespan without increasing the risk of bleeding. However, as citrate binds to calcium and is reduced to bicarbonate, RCA may lead to electrolyt and acid-base disturbances. Methods A retrospective analyses were performed in all children treated with CRRT and RCA at a PICU in a academic children´s hospital over a three year period. RCA was performed using a pre-dilution citrate solution to achieve a circuit citrate concentration of 3mmol/l blood flow and aiming for an extracorporeal ionised calcium (iCa) of 0.25-0.35mmol/l. Calcium was re-infused to the patient aiming for a systemic iCa of 0.9–1.2mmol/l. Results Twenty five patients (mean age: 7.2 years, mean duration of CRRT: 154 hours) were analysed. Episodes of metabolic disturbances detected during CRRT were: Hyponatremia: mild (130-135mmol/l), n=271, severe (<130), n=5; Hypernatremia: mild (145–150), n=2, severe (>150), n=0; Hypokalemia: mild (2.5–3.5mmol/l), n=349, severe (<2.5l), n=1; Hyperkalemia: mild (5.5-7l), n=2, severe (>7), n=0; Hypomagnesaemia: mild (0.35-7mg/dl), n=148, severe (<0.35), n=1; Hypermagnesaemia: mild (1.0–1.6), n=147, severe (>1.6), n=15; Hypophosphataemia:, mild (0.65–1.05mg/dl), n=426, severe (<0.65), n=127; Hyperphosphataemia: mild (1.7–2.0), n=31, severe (>2.0), n=11; Hypocalcaemia: mild (1.75–2.2mmol/l), n=83, severe (<1.75); n=7; Hypercalcaemia: mild (2.7–3.1), n=98, severe (>3.1), n=22; metabolic acidosis: mild (7.25–7.35), n=127, severe (<7.25), n=52; metabolic alkalosis: mild (7.45–7.55), n=268, severe (>7.55), n=16. Conclusions Metabolic disturbances during CRRT with RCA are common and mostly mild in nature. A strict protocol with rigourous monitoring is mandatory to ensure patient safety during RCA.