AI Article Synopsis
- The study aimed to explore how sodium citrate is processed in critically ill patients, especially focusing on those with liver dysfunction.
- The research involved a cohort of both cirrhotic and noncirrhotic patients receiving sodium citrate and calcium chloride infusions, with blood tests conducted to assess how the drug was metabolized.
- Results indicated that cirrhotic patients had a significantly decreased ability to clear citrate compared to noncirrhotic patients, highlighting the importance of considering liver function in the clinical use of citrate, especially for anticoagulation in critically ill scenarios.
Article Abstract
Objectives: To investigate pharmacokinetics and metabolism of sodium citrate in critically ill patients. To determine the risk of citrate accumulation in the setting of liver dysfunction (cirrhosis, hepatorenal syndrome).
Design: Prospective cohort study.
Setting: Intensive Care Unit, Department of Medicine IV, University Hospital Vienna.
Patients: Consecutive critically ill cirrhotic (n = 16) and noncirrhotic patients (n = 16).
Interventions: Infusion of sodium citrate (0.5 mmol.kg-1.hr-1) and calcium chloride (0.17 mmol.kg-1.hr-1) for 2 hrs. Analysis of serial arterial blood samples.
Measurements And Main Results: Total body clearance of citrate was normal in noncirrhotic critically ill patients but significantly reduced in cirrhotic patients (710 vs. 340 mL/min, p =.008). Citrate peak concentrations and concentration over time were increased by 65% and 114% in cirrhotic patients (p <.001), respectively; volumes of distribution were similar. Net metabolic changes were quantitatively similar, with pH and plasma bicarbonate concentrations increasing more slowly in cirrhotic patients. No citrate-related side effects were noted. Citrate clearance could not be predicted by standard liver function tests and was not appreciably influenced by renal function and Acute Physiology and Chronic Health Evaluation II scores.
Conclusions: This first systematic study on citrate pharmacokinetics and metabolism in critically ill patients confirms a major role of hepatic citrate metabolism by demonstrating reduced citrate clearance in cirrhotic patients. Pharmacokinetic data could provide a basis for the clinical use of citrate anticoagulation in critically ill patients. Provided dose adaptation and monitoring of ionized calcium, citrate anticoagulation seems feasible even in patients with decompensated cirrhosis. Metabolic consequences of citrate infusion were not different between groups in this study but may be more pronounced in prolonged infusion.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/01.CCM.0000084871.76568.E6 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Extracorporeal membrane oxygenation and pregnancy.
Best Pract Res Clin Anaesthesiol
September 2024
Department of Anaesthesiology, University Hospitals Leuven (BE), Department of Cardiovascular Sciences, KU Leuven (BE), Herestraat 49, B-3000, Leuven, Belgium.
Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods.
View Article and Find Full Text PDFDetection of neurologic changes in critically ill infants using deep learning on video data: a retrospective single center cohort study.
EClinicalMedicine
December 2024
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Background: Infant alertness and neurologic changes can reflect life-threatening pathology but are assessed by physical exam, which can be intermittent and subjective. Reliable, continuous methods are needed. We hypothesized that our computer vision method to track movement, pose artificial intelligence (AI), could predict neurologic changes in the neonatal intensive care unit (NICU).
View Article and Find Full Text PDFDigital health interventions in adult intensive care and recovery after critical illness to promote survivorship care.
J Intensive Care Soc
January 2025
Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Digital health refers to the field of using and developing technology to improve health outcomes. Digital health and digital health interventions (DHIs) within the area of intensive care and critical illness survivorship are rapidly evolving. Digital health interventions refer to technologies in clinical interventional format.
View Article and Find Full Text PDFIntroduction The pediatric intensive care unit (PICU) is a specialized area for treating critically ill infants and children. However, some of these children may experience poor outcomes, including death. However, it is necessary to predict the prognosis for critically ill patients as early as possible to commence triage as well as an early and effective intervention to prevent mortality.
View Article and Find Full Text PDFExtension of an ICU-based noninvasive model to predict latent shock in the emergency department: an exploratory study.
Front Cardiovasc Med
December 2024
Emergency Center, Hubei Clinical Research Center for Emergency and Resuscitaion, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Background: Artificial intelligence (AI) has been widely adopted for the prediction of latent shock occurrence in critically ill patients in intensive care units (ICUs). However, the usefulness of an ICU-based model to predict latent shock risk in an emergency department (ED) setting remains unclear. This study aimed to develop an AI model to predict latent shock risk in patients admitted to EDs.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!