Zero balance ultrafiltration for the correction of acute acidosis after a period of prolonged deep hypothermic circulatory arrest.

A 36-year-old woman with normal renal function underwent a total arch replacement requiring 110 minutes of deep hypothermic circulatory arrest. Prior to rewarming, a pH of 7.063 with a base deficit of 10.8 was obtained. Zero-balance ultrafiltration (Z-BUF) was initiated during rewarming 7 minutes after resumption of cardiopulmonary bypass. After one hour (10L) of Z-BUF, all electrolyte and acid-base disturbances were fully corrected. Our case illustrates that Z-BUF offers a valuable option for the correction of severe electrolyte and acid-base disturbances in adults undergoing cardiac surgery. Its use should be considered in addition to the more standard pharmacologic approaches to such derangements as it offers rapid and predictable electrolyte and acid-base correction and potential anti-inflammatory benefits.