Sodium Citrate / Citric Acid

Trade Names:
Bicitra
- Solution 500 mg sodium citrate/334 mg citric acid per 5 mL (1 mEq sodium equiv. to 1 mEq bicarbonate/mL)

Trade Names:
Oracit
- Solution 490 mg sodium citrate/640 mg citric acid per 5 mL (1 mEq sodium equiv. to 1 mEq bicarbonate/mL)

Pharmacology

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Sodium citrate is metabolized to sodium bicarbonate, thus acting as a systemic alkalizer.

Indications and Usage

Long-term maintenance of an alkaline urine; alleviation of chronic metabolic acidosis; buffering and neutralizing gastric hydrochloric acid.

Contraindications

Patients on sodium-restricted diets; impaired renal function with oliguria, azotemia, or anuria; untreated Addison disease; adynamia episodica hereditaria; acute dehydration; heat cramps; severe myocardial damage; hyperkalemia.

Dosage and Administration

PO 2 to 6 tsp (10 to 30 mL), diluted in 1 to 3 oz of water, after meals and at bedtime, or as directed by health care provider.

PO 1 to 3 tsp (5 to 15 mL), diluted in 1 to 3 oz of water, after meals and at bedtime, or as directed by health care provider.

PO 3 tsp (15 mL), diluted in 15 mL of water, taken as a single dose, or as directed by health care provider.

Storage/Stability

Store syrup at controlled room temperature (59° to 86°F). Keep tightly capped and protect from freezing or excessive heat.

Drug Interactions

Urinary alkalinizers may decrease the excretion and increase the serum levels of these agents, possibly increasing their pharmacologic effects.

Urinary alkalinizers may increase the excretion and decrease the serum levels of these agents, possibly decreasing their pharmacologic effects.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Generally well tolerated when taken in recommended doses by patients with normal renal function and urinary output.

Metabolic

Hypernatremia; metabolic alkalosis.

GI

Diarrhea; loose bowel movements.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Renal Function

Because alkalosis can occur, especially in the presence of hypocalcemia, use with caution.

Special Risk Patients

Sodium salts should be used with caution in patients with cardiac failure, hypertension, impaired renal function, peripheral and pulmonary edema, and toxemia of pregnancy.

GI effects

Dilute with water to minimize GI disturbance. Take after meals to avoid saline laxative effect.

Urolithiasis

Citrate mobilizes calcium from bones and increases its renal excretion; this, along with the elevated urine pH, may predispose to urolithiasis.

Overdosage

Symptoms

Diarrhea, nausea, vomiting, hypernoia (excessive mental activity), convulsions.

Patient Information

• Advise patient to take as prescribed and not to change the dose or stop taking unless advised by health care provider.
• Advise patient to dilute each dose with 1 to 3 oz of cold water and take after meals if possible to prevent laxative effect. Additional water may follow the dose if desired.
• Advise patient that if a dose is missed, to take as soon as remembered unless it is nearing time for the next dose. Caution patient against doubling the dose to catch up.
• Advise patient to inform health care provider if any of the following occur: edema, nausea, stomach pain, vomiting, decreased urine production, persistent diarrhea, or any other bothersome adverse reactions.
• Advise patient to avoid salty foods and use of extra table salt.

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