patients with associated liver impairment. Furthermore, due to its
vasodilator properties and non-physiologic pH, lactate could cause
hypotension and worsen acidosis due to accumulation of lactate.CRRT solutions for dialysate and replacement fluid
Dialysates are iso-osmotic solutions with physiologic concentrations of
electrolytes and glucose. The lack of urea and other non-desired
metabolic byproducts in the dialysate solution creates a concentration
gradient by which these solutes are cleared from the blood. High
concentrations of urea, potassium and phosphorus in blood of patients
with renal failure are easily eliminated through the membrane both by
convection (ultrafiltrate) and diffusion (low or physiologic concentrations in
the dialysate solution).
Bicarbonate-based fluid is preferred over lactate-based due to the risk of
metabolic acidosis leading to cardiac dysfunction, vasodilatation, and
hypotension.[8]
Solutions without calcium are utilized when citrate anticoagulation is used.
Albumin can be added to the dialysate fluid to help eliminate protein
bound drugs.
Dialysate solutions are warmed to a temperature of 35 to 37o to avoid
hypothermia.Circuit flow rate
Blood flow (Qb) should be started below the goal rate and advanced to
maximum rate over 30 min. Flow rates vary from to 10 - 12 mL/kg/min in
neonates and 2-4 mL/kg/min in older children and adolescents. [7]
Usually the dialysate flow (Qd) is matched to the Qb to allow maximal
exposure time.