Citrate

Intoxication
Citrate- anticoagulant used in blood products

A condition that may develop during massive

replacement therapy with transfused blood that
contain citrate.
Risk Factors in
Citrate
administration

Massive transfusion
(citrate is used as a
preservative)

Regional citrate
anticoagulation for
RRT
 Risk Factors
In;
Decreased Citrate Clearance
Liver failure

Decreased cardiac output

Exacerbating factors
Hypocalcemia

Hypoalbuminemia
 Clinical
manifestation
Hypocalcemia (decreased iCa, normal total

Ca as bound to citrate)

Anxiety, Paraesthesia, Carpopedal Spasm,

Tetany, Seizures

Nausea and Vomiting

Long QT, Dysrhythmias

Other
metabolic and
electrolyte
disturbances

Metabolic alkalosis due to HCO3

formation (3 HCO3 for each citrate
molecule)
Hypernatremia
Hypomagnesemia
Hypokalemia
Management
Stop citrate administration

Treat life-threatening hypocalcemia

with IV calcium (either calcium
gluconate or chloride)

Optimise cardiac output and liver

function to enhance citrate
clearance