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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Volume 44, Issue 8


Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium

Andries J. Bakker
  • Department of Clinical Chemistry, Stichting Klinisch Chemisch Laboratorium, Leeuwarden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ E. Christiaan Boerma
  • Department of Intensive Care Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Halbe Keidel
  • Department of Clinical Chemistry, Stichting Klinisch Chemisch Laboratorium, Leeuwarden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter Kingma
  • Department of Intensive Care Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter H.J. van der Voort
  • Department of Intensive Care Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2006-07-31 | DOI: https://doi.org/10.1515/CCLM.2006.164


Background: The objective of this study was to elucidate the most practical and effective laboratory measurement for monitoring citrate in critically ill patients undergoing citrate-anticoagulated continuous venovenous haemofiltration (CVVH).

Methods: This observational study was performed at the mixed medical and surgical intensive care unit of a regional teaching hospital. The study population comprised ten consecutive critically ill patients with acute renal failure and indication for haemofiltration with the use of regional anticoagulation with citrate. Serum samples for the measurement of citrate and total and ionised calcium were taken from the pre- and post-filter compartments and from the arterial circulation of patients during citrate-anticoagulated CVVH.

Results: Receiver operating characteristic (ROC) curve analysis showed that for detecting citrate overdose (defined as a citrate concentration >1.0mmol/L) the best cut-off limits for total/ionised calcium and ionised calcium were 2.1 and 0.8mmol/L, respectively. Sensitivity and specificity for the cut-off limit of 2.1 for total/ionised calcium were 89% and 100%, and 84% and 100%, respectively, for the cut-off limit of 0.8mmol/L for ionised calcium.

Conclusions: In patients without liver insufficiency, total/ionised calcium performed slightly better than ionised calcium in detecting elevated citrate concentrations. However, because of the simplicity of its measurement, ionised calcium is preferred. Measurement of citrate is not necessary.

Clin Chem Lab Med 2006;44:962–6.

Keywords: Catot/Ca2+ ratio; citrate; citrate intoxication; continuous venovenous haemofiltration; ionised calcium; receiver operating characteristic (ROC) curve analysis


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About the article

Corresponding author: Dr. A.J. Bakker, Department of Clinical Chemistry, Klinisch Chemisch Laboratorium, P.O. Box 850, 8901 BR Leeuwarden, The Netherlands Phone: +31-582888444, Fax: +31-582882227,

Received: 2006-01-24

Accepted: 2006-04-20

Published Online: 2006-07-31

Published in Print: 2006-08-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 44, Issue 8, Pages 962–966, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2006.164.

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©2006 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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