Based on recent recommendations, the use of Regional Citrate Anticoagulation (RCA) is likely to increase dramatically throughout the world. RCA protocols should aim to minimize the amount of net citrate load delivered to the patient. In case of acid-base derangement during RCA, clinicians should be able to differentiate a benign citrate net overload (alkalosis) from a life-threatening accumulation (elevated Ca/Ca++, increase need for calcium substitution, and trend toward acidosis), which should prompt therapy tuning and early termination. The distinction between these two entities is crucial to enable adequate patient surveillance while receiving RCA.

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