Profound Hypercalcemia in Continuous Veno-Venous Hemofiltration Dialysis with Trisodium Citrate Anticoagulation and Hepatic Failure

Continuous hemodialysis, either arteriovenous or veno-venous, is increasingly used in critically ill patients with acute renal failure. Trisodium citrate has become popular as a regional anticoagulant for these procedures to minimize the risk of hemorrhage and thrombocytopenia associated with heparin (1). Excess calcium citrate and citrate ions are removed by dialysis enhanced by calcium-free, alkali-free dialysate, thus requiring a CaCl2 infusion to maintain serum calcium. Noncritical hypocalcemia and metabolic alkalosis have been associated with such treatment (2). We recently observed a patient who developed profound hypercalcemia while undergoing continuous veno-venous hemofiltration dialysis (CVVHD). This 76-year-old man had a long history of myasthenia gravis, non-insulin-dependent diabetes mellitus, …