Prevention of Citrate Intoxication During Exchange Transfusions

Abstract

CITRATE INTOXICATION, which can result from the use of large amounts of stored blood containing the anticoagulant, acid-citrate-dextrose (ACD) solution, has been shown to be a danger in experimental animals^1-4 and in clinical cases.⁵ Infusions of the ACD solution alone into laboratory animals can produce the same untoward effects. The citrate itself, low pH, lack of ionized calcium, excess potassium, and alterations in the potassium: calcium ratio have each been considered the dangerous factor. Foote, Trede, and Maloney₆ successfully used ACD blood to prime heart-lung machines after giving sufficient calcium to the patient to reverse the alterations in the electrocardiogram. Bunker and associates⁷ were able to reverse the effects of sodium citrate by the intravenous administration of calcium chloride, but they found that the increase in ionized calcium in the blood could not be predicted on the basis of the amount of calcium administered. When the