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I& #39;ve been asked about home-made #CRRT solutions for the pandemic. For safety reasons, I believe in using pre-made solutions with limited customization whenever possible. However, I realize that some institutions are running out of solutions. I offer the following Tweetorial:
CJASN just published a nice review for how to address resource allocation for dialysis and CRRT: https://tinyurl.com/rklnuen
In">https://tinyurl.com/rklnuen&q... this paper they provide a 4 solution recipe to make a Calcium-containing CRRT solution. The solution can be made by pharmacy using TPN Compounders.
In">https://tinyurl.com/rklnuen&q... this paper they provide a 4 solution recipe to make a Calcium-containing CRRT solution. The solution can be made by pharmacy using TPN Compounders.
That CJASN solution contains calcium, therefore it shouldn& #39;t be used where citrate anticoagulation is used for CRRT. In the early days of CRRT, we made a no-calcium CRRT solution from 2 base solutions that were infused simultaneously at equal rates. https://tinyurl.com/vghskxe ">https://tinyurl.com/vghskxe&q...
Run equal parts of these 2 solutions together:
Solution A = 0.9% NS + 6 mEq KCL
Solution B = 0.45% Saline + 50 mEq NaHCO3
Yields a final CRRT solution that contains:
Na=141 mEq/L, K=3 mEq/L, Cl=119 mEq/L, Bicarb=25mEq/L
That is a pretty good base CRRT solution in a pandemic pinch
Solution A = 0.9% NS + 6 mEq KCL
Solution B = 0.45% Saline + 50 mEq NaHCO3
Yields a final CRRT solution that contains:
Na=141 mEq/L, K=3 mEq/L, Cl=119 mEq/L, Bicarb=25mEq/L
That is a pretty good base CRRT solution in a pandemic pinch
Hospital pharmacies should have all the ingredients for this in stock already. Omit the K if you need/want to. Monitor Mg, Phos as usual. Monitor calcium as you would if you use citrate anticoagulation.
Important: Run the bags simultaneously at equal rates!
Important: Run the bags simultaneously at equal rates!
Contrary to popular belief, you don& #39;t need dextrose in a CRRT solution. Don& #39;t believe it? Plasma water is ~100mg/dL (1G/L) glucose. If you ran CRRT effluent at a typical 2L/hr, you& #39;d remove 2 g/hr of glucose. This is the same amount of sugar as 3 M&Ms. https://tinyurl.com/uo36c9a ">https://tinyurl.com/uo36c9a&q...
Three M&Ms/hr is an inconsequential glucose loss and won& #39;t be a cause of hypoglycemia. If you run ACD as anticoagulant, you are already giving a bunch of dextrose anyway. Finally, the above recipe should work for CVVH, CVVHD, CVVHDF and can be used as a dialysate or an infusate.
