The use of citrate as an anticoagulant in continuous renal replacement therapy is an effective method to achieve regional anticoagulation of the extracorporeal blood circuit and to avoid systemic anticoagulation. This allows bleeding complications to be reduced and filter life time to be prolonged. However, citrate enters the systemic circulation and is metabolized in the liver to bicarbonate, causing metabolic alkalosis in some patients. In this case report, we discuss therapeutic interventions to control the acid-base status and to restore normal pH during continuous citrate hemodialysis.
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