Hypocitraturia Despite Potassium Citrate Tablet Supplementation

Chetan Shenoy, MBBS


July 13, 2006


Citrate inhibits renal stone recurrence by preventing crystal growth, aggregation, and nucleation. It is a strong chelator of calcium and one of the most common therapeutic agents used to prevent calcium oxalate, uric acid, or cystine stones because of its ability to alkalinize urine and decrease urinary supersaturation for calcium oxalate. Gastrointestinal absorption of citrate is less efficient from a tablet preparation of potassium citrate than from a liquid preparation. Chronic diarrhea leads to decreased absorption and increased loss of the citrate from the gastrointestinal tract, leading to decreased urinary excretion. We describe a patient with nephrolithiasis and chronic diarrhea who had severe hypocitraturia despite citrate supplementation by the slow-release tablet preparation and a normal urinary citrate level after she was switched to the liquid preparation. We hypothesize that the decreased gastrointestinal transit time from her diarrhea led to inadequate absorption of citrate from the slow-release wax-matrix tablets.


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