I'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: tinyurl.com/rklnuen
In 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 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'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. tinyurl.com/vghskxe
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't need dextrose in a CRRT solution. Don't believe it? Plasma water is ~100mg/dL (1G/L) glucose. If you ran CRRT effluent at a typical 2L/hr, you'd remove 2 g/hr of glucose. This is the same amount of sugar as 3 M&Ms. tinyurl.com/uo36c9a
Three M&Ms/hr is an inconsequential glucose loss and won'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.
