Sodium citrate is converted in the body and converted to bicarbonate. It is used to treat the following disorders:

• Treatment of metabolic acidosis in patients with renal tubular acidosis.
• For heartburn to neutralize gastric acidity
• To alkaline urine in certain conditions like patients with pigment nephropathy and rhadomyolysis.

Sodium citrate and citric acid Dose in Adults

• Dose in Acidosis or systemic alkalization:
  •  10 to 30 mL every six hourly
• Dose in patients with heart burn.
  • 15 to 30 mL as a single dose.

Sodium citrate and citric acid Dose in Childrens:

Note:1 mL of oral solution contains 1 mEq of bicarbonate and 1 mEq of sodium.

Type 1 (distal) Renal tubular acidosis:

• Infants, Children, and Adolescents:
  • 2 to 4 mEq bicarbonate/kg/day equivalent to 2 to 4 mL/kg/day of sodiumcitrate in divided doses. Adjust the dose to the target serum bicarbonate levels

Proximal (Type 2) Renal tubular acidosis (RTA):

• Infants, Children, and Adolescents:
  • 10 to 20 mEq bicarbonate/kg/day in divided doses. it may be used in combination with potassium citrate to achieve the target bicarbonate levels

For Systemic alkalinization:

• Children older than 2 years and Adolescents:
  •  5 to 15 mL (5 to 15 mEq bicarbonate) per dose after meals and at bedtime
• Infants, Children, and Adolescents:
  • 2 to 3 mEq bicarbonate/kg/day (2 to 3 mL/kg/day) in 3 to 4 divided doses.
  • Adjust the dose to the target serum bicarbonate levels.
  • The typical adult dose does not exceed 30 mEq/dose or 30 mL/dose

Pregnancy Risk Factor not established

Use with caution in patients with toxemia of pregnancy.

Sodium citrate and citric acid Dose in Kidney Disease:

According to the manufacturer, dose adjustment in patients with renal disease is not required.

• Use is contraindicated in patients with:
  • anuria,
  • severe renal impairment,
  • oliguria,
  • azotemia.

Sodium citrate and citric acid Dose in Liver Disease:

Patients with liver disease do not require any adjustment in the dose.

Side effects of sodium citrate:

• Central nervous system:
  • Tetany
• Endocrine and metabolic:
  • Metabolic alkalosis
• Gastrointestinal:
  • Diarrhea,
  • nausea,
  • vomiting

Contraindication to sodiumcitrate and citric acid include:

• Hypersensitivity
• Grave renal impairment
• Oliguria
• Azotemia
• Addison disease untreated
• Adynamia episodica hereditaria
• Acute dehydration
• Heat cramps
• Anuria
• Severe myocardial damage
• Hyperkalemia
• Sodium-restricted diet.

Warnings/Precautions

• Cardiovascular disease
• Edema
• Hepatic impairment
• Renal impairment
• Patients who are seriously ill
• Shock

Sodium citrate and citric acid (oral solution): Drug Interaction

Monitoring Parameters:

Monitor baseline serum creatinine, BUN and liver funnction tests, as well as serum bicarbonate and urinary pH. Periodic monitoring should always be performed as needed.

How to take sodium citrate and citric acid?

Administer dose after meals. When used for systemic alkalinization or acidosis, it may be administered after meals and at bedtime.

Mechanism of action of sodium citrate and citric acid:

It is converted to sodium bicarbonate, which buffers acid.

It is used to alkalize urine in patients suffering from renal tubular acidosis. 95% of it'sMetabolizedvia hepatic bicarbonate oxidation. Patients with severe illness, shock, or hepatic impairment may have difficulty converting citrate to bicarbonate. It is mostlyexcretedVia urine

International Brands of Sodium citrate and citric acid

• Cytra-2
• Oracit
• Shohl's Solution (Modified)
• PMS-Dicitrate
• Virtrate-2

Sodium citrate and citric acid Brands in Pakistan: