Potassium citrate
Potassium citrate is an oral alkalinizing agent used primarily to manage and prevent **calcium oxalate urolithiasis** in dogs and cats. It works by increasing urine pH and binding with calcium in the urine. > **Clinical Pearl:** While effective for calcium oxalate prevention, it should not be used in patients with struvite stones, which thrive in alkaline urine.
Mechanism: Enhances renal tubular resorption of calcium, and alkalinizes urine. → Citrate is metabolized in the liver to **bicarbonate**, which increases systemic blood and urine pH. → Citrate also binds to calcium in the urine, forming soluble calcium citrate complexes, thereby reducing the availability of calcium to form insoluble calcium oxalate crystals.
Routes of administration
Contraindications
- Renal failure or severe renal impairment
- Hyperkalemia
- Metabolic alkalosis
- Struvite urolithiasis (requires acidic urine)
Adverse effects
- Gastrointestinal upset (nausea, vomiting, diarrhea)
- Hyperkalemia (rare if renal function is normal)
Drug interactions
- Spironolactone · Increased risk of hyperkalemia due to potassium-sparing effects · major
- ACE inhibitors (e.g., Benazepril, Enalapril) · Increased risk of hyperkalemia · moderate
- NSAIDs · May increase the risk of hyperkalemia in compromised patients · minor
Monitoring
- Urine pH
- Serum potassium levels
- Renal function (BUN, Creatinine)
- Urinalysis (for crystal formation)
Overdose
Overdosage may lead to **hyperkalemia** and **metabolic alkalosis**. Clinical signs of hyperkalemia include muscle weakness, bradycardia, and potentially fatal cardiac arrhythmias. Treatment involves discontinuing the supplement, administering non-potassium containing IV fluids, and potentially using calcium gluconate, dextrose, and insulin in severe cases.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.