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

• Patients with renal tubular acidosis should get treatment for metabolic acidosis.
• In order to treat heartburn and balance stomach acid
• in some cases, such as those involving rhabdomyolysis and individuals with pigment nephropathy, to alkalize urine

Sodium citrate and citric acid Dose in Adults

Sodium citrate and citric acid Dose in Acidosis or systemic alkalization:

• A dose of 10 to 30 milliliters of a solution containing sodium citrate and citric acid.
• This solution is usually taken orally (by mouth) and is typically recommended to be taken four times a day.

Sodium citrate and citric acid Dose in patients with heartburn.

• The recommended dose of sodium citrate and citric acid is typically 15 to 30 milliliters taken orally as a single dose.
• This solution works to neutralize excess stomach acid, providing relief from symptoms like heartburn or indigestion.

Sodium citrate and citric acid Dose in Children:

Note: This solution helps to balance the acidity in the stomach, providing relief from symptoms like heartburn or indigestion. Each milliliter of the oral solution contains 1 milliequivalent (mEq) of bicarbonate and 1 mEq of sodium.

Sodium citrate and citric acid Type 1 (distal) Renal tubular acidosis:

In infants, children, and adolescents:

• The typical dose of sodium citrate and citric acid is 2 to 4 milliequivalents (mEq) of bicarbonate per kilogram of body weight per day, taken orally.
• This translates to about 2 to 4 milliliters per kilogram per day, divided into several doses throughout the day.

Sodium citrate and citric acid Proximal (Type 2) Renal tubular acidosis (RTA):

In infants, children, and adolescents:

• the typical dose of sodium citrate and citric acid can vary based on age and individual needs.
• Typically, the range falls between 10 to 20 milliequivalents (mEq) of bicarbonate per kilogram of body weight per day, taken orally and divided into several doses throughout the day.

Sodium citrate and citric acid For Systemic alkalinization:

The dosing of sodium citrate and citric acid can vary depending on age and weight.

• For children aged 2 years and older, as well as adolescents, a volume-based dosing is typically recommended, with a range of 5 to 15 milliliters (which equals 5 to 15 milliequivalents of bicarbonate) to be taken orally per dose after meals and at bedtime.

For infants, children, and adolescents, weight-based dosing is also considered.

• The typical range is 2 to 3 milliequivalents of bicarbonate per kilogram of body weight per day, divided into 3 to 4 doses throughout the day.
• It's important to adjust the dose based on targeted serum bicarbonate levels, and typical adult doses should not exceed 30 milliequivalents per dose.

Pregnancy Risk Factors not established

• Caution is advised when using sodium citrate and citric acid in the treatment of chronic systemic alkalinization, particularly in cases of toxemia of pregnancy.

Sodium citrate and citric acid Dose in Kidney Disease:

• Dosage adjustments for sodium citrate and citric acid are not provided in the manufacturer's labeling.
• The use of this medication is contraindicated in patients with conditions such as anuria (complete absence of urine production), severe renal impairment (significant kidney dysfunction), oliguria (reduced urine output), or azotemia (buildup of nitrogen waste products in the blood).

Sodium citrate and citric acid Dose in Liver Disease:

• Dosage adjustments for sodium citrate and citric acid are not specified in the manufacturer's labeling for patients with hepatic impairment (liver dysfunction).

Side effects of sodium citrate:

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

Contraindications to sodium citrate and citric acid include:

• If someone is allergic to sodium citrate, citric acid, or any part of the medication, or if they have serious kidney problems, low urine output, high levels of nitrogen in the blood (azotemia), untreated Addison's disease, or certain inherited disorders like adynamia episodica hereditaria, they shouldn't take this medicine.
• It's also not safe for people with acute dehydration, severe heart muscle damage, too much potassium in the blood, those on a low-sodium diet, or if they can't produce urine at all (anuria).

Warnings/Precautions

Cardiovascular disease:

• If you have heart failure or high blood pressure, be cautious when using this medication because it contains sodium, which can affect your cardiovascular health.

Edema:

• If you have swelling in your legs (peripheral edema) or lungs (pulmonary edema), be careful when using this medication because it contains sodium, which could potentially worsen fluid retention and swelling.

Hepatic impairment:

• If you have liver problems or hepatic failure, be cautious when using this medication because your liver may have difficulty converting it to bicarbonate, which could affect its effectiveness.

Renal impairment:

• If you have kidney problems or renal impairment, be cautious when using this medication because it contains sodium, which can affect your kidneys.
• It's important to use it with care and under the guidance of a healthcare provider, especially if your kidney function is reduced.
• This medication should not be used in patients with severe kidney impairment, low urine output (oliguria), high levels of nitrogen in the blood (azotemia), or complete absence of urine production (anuria).

Severely ill:

• If you're severely ill, it's important to be cautious when using this medication because your body's ability to convert it to bicarbonate may be impaired.

Shock:

• If someone is experiencing shock, they should use this medication with caution because their body's ability to convert it to bicarbonate might be impaired.

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

Monitoring Parameters:

• Baseline Assessment: Before starting the treatment, your healthcare provider may check your serum creatinine, blood urea nitrogen (BUN), liver function tests (LFTs), serum bicarbonate levels, and urinary pH.
• Ongoing Monitoring: Throughout the treatment, your healthcare provider may monitor these levels periodically, especially if you have kidney disease. This monitoring helps ensure that the treatment is working effectively and safely for you.
• Serum Electrolytes: Your healthcare provider may pay special attention to your serum electrolyte levels, particularly bicarbonate, if you have kidney disease. Keeping an eye on these levels helps in managing your condition and adjusting the treatment as needed to maintain your health.

How to take sodium citrate and citric acid?

• Timing: Take the medication after meals.
• For Acidosis/Systemic Alkalinization: If you're using the medication to treat acidosis or to balance the body's acidity, take it after meals and at bedtime. This timing helps ensure that the medication is effective in managing your condition throughout the day and night.

Mechanism of action of sodium citrate and citric acid:

Metabolism:

• Over 95% of the medication is processed in the liver, where it's oxidized to bicarbonate.
• However, this process might not work as well in patients with hepatic failure, shock, or severe illness, potentially affecting the medication's effectiveness.

Excretion:

• The medication is primarily eliminated from the body through urine, with less than 5% excreted as sodium citrate.
• This means most of the medication is broken down and removed from your body through your urine.

International Brands of Sodium citrate and citric acid

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

Sodium citrate and citric acid Brands in Pakistan: