CRRT on the Razor’s Edge

CRRT on the Razor’s Edge

A Complete Intensivist Guide to Monitoring & Anticoagulation Crisis Management

CRRT is not “set and forget.” The machine is a living part of your patient’s physiology — and the moment it’s treated otherwise is the moment a circuit clots, a calcium level collapses, or a citrate infusion quietly poisons a patient in liver failure. This guide is built for exactly that razor’s edge: the ongoing monitoring and anticoagulation crises that a clean circuit setup does nothing to prevent.

What’s inside

• Five core monitoring domains — circuit, clinical, dose, and biochemical monitoring, plus a dedicated anticoagulation crisis chapter
• Circuit surveillance — TMP trends and filter-clotting signals read before the circuit fails
• Clinical targets — haemodynamic and fluid-balance goals kept in view, not lost to the machine
• Dose tracking — KDIGO dose delivery and downtime recovery accounted for honestly
• Biochemical picture — the full electrolyte and drug-clearance map on CRRT
• Anticoagulation crisis chapter — heparin over- and under-dosing, regional citrate toxicity with exact Ca:iCa thresholds, argatroban and prostacyclin dosing, the 4T score for HIT, and anticoagulant-free strategies
• Ten fully worked ICU scenarios — citrate toxicity in liver failure, iatrogenic hypercalcaemia, hypomagnesaemia mimicking toxicity, and more — with real biochemical parameters, diagnosis, and minute-by-minute action

Educational reference only — always follow your unit’s local protocols and manufacturer guidance.

By Dr. Gunadhar Padhi — Chief Intensivist, MD, IDCCM, FCCCM, ECMO (Paris); author of the EDIC preparation series.