Usage
- Medical Conditions: Sodium Citrate is prescribed for various medical conditions, including metabolic acidosis (a condition where the body produces too much acid or the kidneys are not removing enough acid), prevention and treatment of uric acid and cystine kidney stones, and treatment of acidosis associated with certain renal tubular disorders. It is also used to alkalinize the urine, which can be beneficial in certain situations such as before surgery to reduce the risk of acid aspiration syndrome.
- Pharmacological Classification: Systemic and urinary alkalinizer, buffering agent.
- Mechanism of Action: Sodium citrate works by increasing the levels of bicarbonate in the body, which helps to neutralize excess acid. It is metabolized to bicarbonate ions, thus increasing serum and urinary bicarbonate levels. This leads to an increase in blood and urinary pH, making them less acidic.
Alternate Names
- Trisodium Citrate Dihydrate
- Brand Names: Bicitra, Cytra-2, Oracit, Shohl’s Solution (Modified), Liqui-Dual Citra.
How It Works
- Pharmacodynamics: Sodium citrate is rapidly absorbed after oral administration and metabolized to bicarbonate ions, thereby increasing serum bicarbonate levels. This leads to an increase in both blood and urine pH, ultimately alkalinizing both.
- Pharmacokinetics:
- Absorption: Readily absorbed from the gastrointestinal tract.
- Metabolism: Metabolized in the liver and muscle tissues to bicarbonate.
- Elimination: Less than 5% is excreted unchanged in the urine. The majority of the citrate is metabolized to bicarbonate and subsequently eliminated as carbon dioxide through respiration or as bicarbonate in the urine.
- Mode of Action: Sodium citrate acts as a buffering agent by reacting with acids in the body to form bicarbonate ions. This process neutralizes excess hydrogen ions and raises the pH. The increase in urinary citrate levels inhibits the crystallization of uric acid and calcium salts, thus preventing kidney stone formation. It does not directly bind to receptors or inhibit enzymes but works by changing the chemical environment.
Dosage
Standard Dosage
Adults:
- Metabolic Acidosis, Kidney Stones, Renal Tubular Disorders: 10 to 30 mL (2 to 6 teaspoonfuls), diluted in 1 to 3 ounces of water, four times daily after meals and at bedtime.
- Preoperative Gastric Acid Buffering: 15 mL (3 teaspoonfuls) diluted in 15 mL of water as a single dose.
Children:
- Metabolic Acidosis, Kidney Stones, Renal Tubular Disorders: 5 to 15 mL (1 to 3 teaspoonfuls), diluted in 1 to 3 ounces of water, after meals and at bedtime. Dosage should be individualized based on the child’s weight and medical condition. For children under two years of age, consult a physician.
- Preoperative Gastric Acid Buffering: Consult a physician for appropriate dosing.
Special Cases:
- Elderly Patients: Use with caution, starting at the lower end of the dosing range. Monitor for electrolyte imbalances and adjust the dose accordingly.
- Patients with Renal Impairment: Contraindicated in severe renal impairment. Use with caution in mild to moderate renal impairment. Closely monitor electrolyte levels and renal function.
- Patients with Hepatic Dysfunction: Use with caution as citrate metabolism may be impaired.
- Patients with Comorbid Conditions: Use with caution in patients with cardiac failure, hypertension, peripheral edema, and toxemia of pregnancy due to the sodium content. Monitor electrolyte levels. For patients with diabetes, note that some liquid formulations may contain sugar.
Clinical Use Cases
- Intubation: 30 mL of 0.3 M solution immediately prior to induction of general anesthesia for aspiration prophylaxis.
- Surgical Procedures: As above, for aspiration prophylaxis.
- Mechanical Ventilation: No specific dosage recommendations. Consider systemic alkalinization dosage if needed for metabolic acidosis.
- Intensive Care Unit (ICU) Use: Dosage is based on the patient’s specific clinical needs and acid-base status. Continuous renal replacement therapy (CRRT) may require adjusted citrate dosing and administration via a dedicated pump.
- Emergency Situations: Dosage adjustments may be necessary depending on the specific emergency and the patient’s condition.
Dosage Adjustments:
- Adjust the dose based on the patient’s acid-base balance and clinical response. Monitor serum bicarbonate and urinary pH regularly.
Side Effects
Common Side Effects
- Diarrhea
- Nausea
- Vomiting
- Stomach cramps
- Mild tingling in the hands or feet
Rare but Serious Side Effects
- Swelling of the hands/ankles/feet
- Severe tingling/numbness of the hands/feet
- Muscle weakness or twitching
- Fast/slow/irregular heartbeat
- Mental/mood changes (confusion, anxiety, restlessness)
- Seizures
- Black, tarry stools
Long-Term Effects
- With long-term use or high doses, potential for tooth erosion.
Adverse Drug Reactions (ADR)
- Allergic reactions (rash, itching, swelling, dizziness, difficulty breathing) require immediate medical attention.
- Severe electrolyte imbalances (hypocalcemia, hypernatremia, metabolic alkalosis).
Contraindications
- Severe renal impairment, anuria, oliguria
- Addison’s disease
- Adynamia episodica hereditaria
- Severe dehydration
- Hyperkalemia
Drug Interactions
- Aluminum-containing antacids: Increased aluminum absorption.
- Medications affected by urinary pH (e.g., salicylates, amphetamines): Altered excretion.
- Potassium-sparing diuretics: May increase potassium levels.
- Lithium: May increase lithium levels.
- Certain antibiotics (quinolones, tetracyclines): Decreased antibiotic absorption.
Pregnancy and Breastfeeding
- Pregnancy: Use with caution. Sodium citrate may worsen toxemia of pregnancy.
- Breastfeeding: Generally considered safe but consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Alkalinizes urine and blood by metabolizing to bicarbonate ions.
- Side Effects: Diarrhea, nausea, vomiting, stomach cramps, tingling in the hands or feet.
- Contraindications: Severe renal impairment, Addison’s disease, hyperkalemia.
- Drug Interactions: Aluminum antacids, medications affected by urinary pH, potassium-sparing diuretics, lithium.
- Pregnancy & Breastfeeding: Use with caution in pregnancy; generally safe during breastfeeding.
- Dosage: Varies depending on indication and patient-specific factors. See dosage section above.
- Monitoring Parameters: Serum bicarbonate, urinary pH, electrolyte levels, renal function.
Popular Combinations
- Citric acid is often combined with sodium citrate to enhance the alkalinizing effects and improve palatability.
Precautions
- Monitor patients with renal impairment and heart conditions closely.
- Dilute with water before taking.
- Take after meals to reduce gastrointestinal upset.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Sodium Citrate?
A: The dosage varies depending on the condition being treated. See detailed dosage section above.
Q2: How should Sodium Citrate be administered?
A: Orally, diluted in water, usually after meals.
Q3: What are the common side effects?
A: Common side effects include diarrhea, nausea, vomiting, and stomach cramps.
Q4: What are the contraindications for using Sodium Citrate?
A: Contraindications include severe renal impairment, Addison’s disease, and hyperkalemia.
Q5: Can Sodium Citrate be used during pregnancy?
A: Use with caution during pregnancy as it may worsen toxemia.
Q6: Can it be used while breastfeeding?
A: It is generally considered safe, but consult a physician before use.
Q7: How does Sodium Citrate interact with other medications?
A: It can interact with aluminum antacids, medications affected by urinary pH, potassium-sparing diuretics, and lithium.
Q8: What should be monitored while a patient is taking Sodium Citrate?
A: Monitor serum bicarbonate, urinary pH, electrolyte levels, and renal function.
Q9: What is the role of Sodium Citrate in preventing kidney stones?
A: It increases urinary citrate levels, which inhibits the formation of kidney stones.
Q10: What is the difference between Sodium Citrate and Potassium Citrate?
A: Both are alkalinizing agents but have different electrolyte components. Sodium Citrate provides sodium, while Potassium Citrate provides potassium. The choice between them depends on the patient’s electrolyte needs and any concurrent conditions.
