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