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2.6.5
Paediatric CVVH and CVVHD treatment modes
2.6.6
Side effects
Regional anticoagulation
with citrate
Fresenius Medical Care multiFiltrate IFU-EN-UK 15A-2015
The dose of the renal replacement therapy for a paediatric treatment
can be derived from the recommendations for the treatment of adults,
for example, by scaling in accordance with the body surface.
Chadha et al., for example, used a CRRT dose of 2 l/h / 1.73 m² body
surface (Pediatric Nephrol 2002, 17:819-824), following the
recommendation of Ronco et al. (Lancet 2000, 356:26-30) to use a dose
of at least 2 l/h for a typical adult with a body weight of 70 kg.
According to the prescribed procedure, the minimum dose of 100 ml/h
HF solution / dialysate, which can be set in the paediatric mode of the
device, corresponds to a minimum body surface of the patient of
0.087 m², which is considerably less than the typical body weight of an
average newborn and which usually also permits reasonable
treatments for premature infants.
According to the prescribed procedure, the maximum dose of 1500 ml/h
HF solution / dialysate, which can be set in the paediatric mode of the
device, corresponds to a maximum body surface of the patient of
1.04 m², which matches approximately a body weight of 30 kg.
However, it is already possible to change from the paediatric mode of
the device to one of the treatment modes for adults when treating
smaller patients. According to the prescribed procedure, the minimum
dose of 600 ml/h HF solution / dialysate, which can be set with CVVH
or CVVHD in the adult's treatment modes, corresponds to a minimum
body surface of the patient of 0.52 m², which matches approximately a
body weight of 11 kg.
Extracorporeal treatments occasionally cause hypotension, nausea,
vomiting, and cramps in some patients. Pay particular attention to the
package inserts enclosed with the solutions, filters, etc., used.
During extracorporeal treatments, particularly during CRRT treatments,
the concentrations of different electrolytes (sodium, potassium, calcium,
magnesium, phosphate) can become too high or too low and acid-base
disorders can occur. Such situations can be prevented and treated by
selecting adequate CRRT solutions and by an additional substitution of
electrolytes, if necessary.
Note
Electrolyte imbalances (especially hypokalaemia, hypophosphataemia)
are more likely to occur with high CRRT doses, as an unbalanced
composition of the CRRT solution can have a more pronounced effect.
– Metabolic acid-base disorders (acidosis, alkalosis)
– Systemic hypocalcemia or hypercalcemia
– Hypomagnesaemia
– Hypernatraemia
– Side effects caused by a disordered citrate metabolism
Chapter 2: Important information
2-5
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