Optimizing Acid-Base Stability in CVVH: Why Lower Bicarbonate Fluids Outperform Standard Concentrations During Regional Citrate Anticoagulation

Highlights

• Lower bicarbonate replacement fluid (LBF, 22 mmol/l) significantly reduces the risk of pH and bicarbonate excursions compared to high bicarbonate fluid (HBF, 30 mmol/l) during CVVH.
• The use of HBF was associated with a 3.6-fold increased risk of bicarbonate levels falling outside the standard range.
• Importantly, the time to normalize pH in acidotic patients was not delayed by using the lower bicarbonate concentration.
• Regional citrate anticoagulation (RCA) acts as a significant endogenous source of bicarbonate, necessitating a reduction in exogenous bicarbonate to prevent metabolic overcorrection.

Introduction: The Challenge of Acid-Base Homeostasis in CRRT