Case 44: Diagnostic Testing

Case 44 Index

Basic Labs are obtained:Case 44 BMP

Basic Lab Ref

The nurses asks you what can be done to improve the circuit issues. What is the best next step?
Increase the blood flow rate
Increasing the blood flow rate would help reduce the filtration fraction however, the filtration fraction is already less than 20-25%. Try again!
Increase the citrate concentration in the replacement fluid
Correct! The post-filter ionized calcium is above our target level. A level of <  0.4 mmol/L suggests adequate anticoagulation.
Switch to post-filter replacement fluid (RF)
Switching to post-filter RF will likely increase the likelihood of clotting, Try again!
Increase the replacement fluid rate
Since this patient is getting post-filter repletion, increasing the replacement fluid rate would result in a higher ultrafiltration rate without changing the plasma flow rate. This will lead to an increased filtration fraction, which may put the patient at increased risk for clotting. Try again!
Increase the ultrafiltration rate
Increasing the ultrafiltration rate will raise our filtration fraction, which may increase the risk of clotting if over 20-25%. Try again!

Click here to make the circuit adjustment and move on!

Case 44 Index
Case 44 Introduction
Case 44 Physical Exam