Adverse effects are related to the extracorporeal nature of the procedure, necessitating vascular access and anticoagulation, and to the replacement fluid. In a review of 5235 procedures undertaken in 627 patients, side-effects were encountered in 12 per cent of treatment sessions while 40 per cent of patients experienced adverse reactions at least once. Most reactions were minor and transient, and included fever, chills, urticaria, nausea, hyper- and hypotension, paresthesias, and hives. These reactions were more common when fresh frozen plasma was used as replacement fluid. Serious adverse effects, including cardiovascular distress, anaphylactic shock, and disease-specific exacerbation of the underlying condition, occur in seven in 1000 procedures. A fatality rate of three in 10 000 procedures has been estimated, with cardiovascular and respiratory causes most often implicated.

Citrate, which depletes calcium (a necessary cofactor in the coagulation cascade) from plasma, can cause hypocalcemia (paresthesias, carpopedal spasm, or arrhythmias). Arrhythmias are more common when plasma electrolytes are concurrently deranged. Because of removal of albumin and other proteins, drugs which are highly protein bound (e.g. aminoglycosides, Coumadin (warfarin)) should be closely monitored and dosages adjusted.

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Sleep Apnea

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