{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:14:29Z","timestamp":1792620869620,"version":"4.5.0"},"reference-count":29,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann. Intensive Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Metabolic alkalosis is a frequently occurring problem during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to evaluate the effectiveness of switching from high to low bicarbonate (HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n ) replacement fluid in alkalotic critically ill patients with acute kidney injury treated by CVVH and RCA.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective-comparative study design was applied. Patients who underwent CVVH with RCA in the ICU between 09\/2016 and 11\/2017 were evaluated. Data were available from the clinical routine. A switch of the replacement fluid Phoxilium\n \u00ae<\/jats:sup>\n (30\u00a0mmol\/l HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n ) to Biphozyl\n \u00ae<\/jats:sup>\n (22\u00a0mmol\/l HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n ) was performed as blood HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n concentration persisted\u2009\u2265\u200926\u00a0mmol\/l despite adjustments of citrate dose and blood flow. Data were collected from 72\u00a0h before the switch of the replacement solutions until 72\u00a0h afterwards.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 153 patients treated with CVVH during that period, 45 patients were switched from Phoxilium\n \u00ae<\/jats:sup>\n to Biphozyl\n \u00ae<\/jats:sup>\n . Forty-two patients (42 circuits) were available for statistical analysis. After switching the replacement fluid from Phoxilium\n \u00ae<\/jats:sup>\n to Biphozyl\n \u00ae<\/jats:sup>\n the serum HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n concentration decreased significantly from 27.7\u00a0mmol\/l (IQR 26.9\u201328.9) to 25.8\u00a0mmol\/l (IQR 24.6\u201327.7) within 24\u00a0h (\n p<\/jats:italic>\n \u2009<\u2009\n 0.001<\/jats:italic>\n ). Base excess (BE) decreased significantly from 4.0\u00a0mmol\/l (IQR 3.1\u20135.1) to 1.8\u00a0mmol\/l (IQR 0.2\u20133.4) within 24\u00a0h (\n p<\/jats:italic>\n \u2009<\u2009\n 0.001).<\/jats:italic>\n HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n and BE concentration remained stable from 24\u00a0h till the end of observation at 72\u00a0h after the replacement fluid change (\n p<\/jats:italic>\n \u2009=\u2009\n 0.225<\/jats:italic>\n ). pH and PaCO\n 2<\/jats:sub>\n did not change significantly after the switch of the replacement fluid until 72\u00a0h.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n This retrospective analysis suggests that for patients developing refractory metabolic alkalosis during CVVH with RCA the use of Biphozyl\n \u00ae<\/jats:sup>\n reduces external HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n load and sustainably corrects intracorporeal HCO\n 3<\/jats:sub>\n \u2212<\/jats:sup>\n and BE concentrations. Future studies have to prove whether correcting metabolic alkalosis during CVVH with RCA in critically ill patients is of relevance in terms of clinical outcome.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s13613-021-00850-4","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T06:04:14Z","timestamp":1619157854000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Low bicarbonate replacement fluid normalizes metabolic alkalosis during continuous veno-venous hemofiltration with regional citrate anticoagulation"],"prefix":"10.1016","volume":"11","author":[{"given":"Paul","family":"K\u00f6glberger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian J.","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg Franz","family":"Lehner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romuald","family":"Bellmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Peer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schw\u00e4rzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-0881","authenticated-orcid":false,"given":"Michael","family":"Joannidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"issue":"2","key":"850_CR1","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.ccc.2004.12.005","volume":"21","author":"M Joannidis","year":"2005","unstructured":"Joannidis M, Metnitz PG. 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Paul K\u00f6glberger, Sebastian J. Klein, Georg Franz Lehner, Romuald Bellmann, Andreas Peer and Daniel Schw\u00e4rzler declare having no conflict of interest related to this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"62"}}