ACID-BASE RESPONSES TO HIGH-VOLUME HEMOFILTRATION IN THE CRITICALLY ILL

We have studied the acid-base and cardiorespiratory effects of intermi ttent pumped high-volume venovenous haemofiltration (HVHF) using repla cement fluid containing lactate as the source of bicarbonate in critic ally ill patients. We demonstrated significant hyperlactataemia throug hout the procedure, but there was no deterioration in acid-base status , haemodynamics, or oxygen delivery. These observations suggest that t he worsening of acidosis and the hypotension that have been described with this technique [1] can be avoided by appropriate monitoring and r esuscitation prior to haemofiltration, and may be due to unrecognized inadequacies in the oxygen transport system.