bicarbonate, and use of lactate based dialysis solution may produce or exacerbate lactic acidosis. Bicarbonate buffered dialysis solutions are therefore preferred for patients with hepatic failure. Barenbrock et al demonstrated improved care of the patient when receiving bicarbonate based solutions when compared to lactate. Essentially with the use of these products the use of lactate based solutions should be considered historical and potentially detrimental to the child needed CRRT. Prescriptions Classically, prescriptions for acute HF have been for the treatment of AKI. If one were to suggest a standard prescription, then a BFR for HF would be in the range of 4-6 mls/kg/min (but this can be increased with no risk if the access is sufficient) trying to keep a venous return pressure of less than 200 mm Hg. Further there is no absolute data to date on the rate of replacement fluid or dialysate fluid. Historically we have used a rate of 2000-3000 ml per 1.73 m2 /hr; this allows us to compare pediatric data based on body surface area to adult data. Alternately, 35-40mls/kg/hr is a reasonable rule for replacement dialysis fluid. Net ultrafiltration from the child is determined based upon hemodynamics. A target of 1-2 mls/kg/hr of net UF is reasonable if hemodynamics allow for it. Taking off a lot of fluid at once is risky; reinforcing that early use of HF may be advantageous. Only the hemodynamics will determine what is reasonable. patient’s Nutrition and CRRT When one looks at nutritional requirements of these children it is imperative to
bicarbonate, and use of lactate based dialysis solution may produce or exacerbate lactic acidosis. Bicarbonate buffered dialysis solutions are therefore preferred for patients with hepatic failure. Barenbrock et al demonstrated improved care of the patient when receiving bicarbonate based solutions when compared to lactate. Essentially with the use of these products the use of lactate based solutions should be considered historical and potentially detrimental to the child needed CRRT. Prescriptions Classically, prescriptions for acute HF have been for the treatment of AKI. If one were to suggest a standard prescription, then a BFR for HF would be in the range of 4-6 mls/kg/min (but this can be increased with no risk if the access is sufficient) trying to keep a venous return pressure of less than 200 mm Hg. Further there is no absolute data to date on the rate of replacement fluid or dialysate fluid. Historically we have used a rate of 2000-3000 ml per 1.73 m2 /hr; this allows us to compare pediatric data based on body surface area to adult data. Alternately, 35-40mls/kg/hr is a reasonable rule for replacement dialysis fluid. Net ultrafiltration from the child is determined based upon hemodynamics. A target of 1-2 mls/kg/hr of net UF is reasonable if hemodynamics allow for it. Taking off a lot of fluid at once is risky; reinforcing that early use of HF may be advantageous. Only the patient’s hemodynamics will determine what is reasonable. Nutrition and CRRT When one looks at nutritional requirements of these children it is imperative to