시트르산염 (시트르산 칼륨, 시트르산 나트륨, 시트르산)
Citrate Salts (Potassium Citrate, Sodium Citrate, Citric Acid)
Potassium citrate, Sodium citrate, Citric acid
다른 이름: Nutrived · Urocit-K · Citrolith · Polycitra · Oracit · Bicitra · Cytra · Naturalyte · Citrate of potash · Citric acid tripotassium salt monohydrate · Shohl's solution
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive therapy to inhibit calcium oxalate crystal formation (hypocitraturia) | 40-75 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Adjunctive therapy to inhibit calcium oxalate crystal formation | Initially 50 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Decrease possibility of calcium oxalate stone formation (Nutrived Potassium Citrate Granules) | 1 scoop mixed or sprinkled on food per 10 lb. body weight per day | PO | q24h | — | 🌎 NA |
| Persistent calcium oxalate crystalluria/uroliths (after diet and hydrochlorothiazide) | 50-75 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Adjunctive therapy of chronic renal failure as a potassium supplement and alkalinizing agent | Initially, 75 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
- Adjunctive therapy to inhibit calcium oxalate crystal formation (hypocitraturia): Avoid overzealous urinary alkalinization as calcium phosphate uroliths may form.
- Adjunctive therapy to inhibit calcium oxalate crystal formation: Monitor urine pH; goal is to obtain values of 7-7.5.
- Persistent calcium oxalate crystalluria/uroliths (after diet and hydrochlorothiazide): Give to effect to achieve a urine pH of 6.5-7. If urine pH already above 7-7.5, do not use. Monitor serum potassium monthly.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive therapy to inhibit calcium oxalate formation | Initially 50-100 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Decrease possibility of calcium oxalate stone formation (Nutrived Potassium Citrate Granules) | 1 scoop mixed or sprinkled on food per day | PO | q24h | — | 🌎 NA |
| Adjunctive therapy to inhibit calcium oxalate formation | 100-150 mg/kg/day PO | PO | q24h | — | 🌎 NA |
| Adjunctive therapy of chronic renal failure as a potassium supplement and alkalinizing agent | Initially, 75 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Significantly acidemic chronic renal failure | 2.5 mEq (total dose) potassium or 15-30 mg/kg as potassium citrate PO q12h | PO | q12h | — | 🌎 NA |
| Hypokalemic chronic renal failure | 2-4 mEq (total dose) of potassium per day as potassium citrate or potassium gluconate | PO | q24h | — | 🌎 NA |
- Adjunctive therapy to inhibit calcium oxalate formation: Goal is to achieve a urine pH of approximately 7.5.
- Adjunctive therapy to inhibit calcium oxalate formation: It is unclear whether this dose will actually increase urinary citrate in cats.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
시트르산염은 수의학에서 주로 요 알칼리화제로 사용되며, 만성 신장 질환(CKD)이나 신세관성 산증과 관련된 만성 대사성 산증을 관리하는 데 도움을 줍니다.
특히 시트르산 칼륨은 개와 고양이의 칼슘 옥살레이트 결석 형성을 예방하는 데 매우 유용합니다. 기호성이 좋고, 많은 CKD 환축이 겪기 쉬운 저칼륨혈증에 대비해 칼륨을 보충해 주기 때문에 탄산수소나트륨보다 자주 선호됩니다.
임상 팁: 칼슘 옥살레이트 예방에 매우 효과적이지만, 요 pH가 너무 높아지면 오히려 인산칼슘 결석 형성을 촉진할 수 있으므로 과도한 알칼리화는 피해야 합니다.
작용 기전
Citrate salts are absorbed from the gastrointestinal tract and oxidized in the liver to produce bicarbonate (HCO3-), which acts as a systemic alkalinizing agent, raising blood pH and subsequently urine pH.
In the urinary tract, the mechanism is twofold:
- Alkalinization: The resulting alkaline urine increases the solubility of calcium oxalate.
- Chelation: Excreted citrate directly complexes with calcium in the urine → decreases the concentration of free calcium available to bind with oxalate → inhibits the formation and growth of calcium oxalate crystals.
안전성·주의사항
금기사항
- Heart failure
- Severe renal impairment (with azotemia or oliguria)
- Urinary tract infections (UTI) associated with calcium or struvite stones
- Aluminum toxicity
- Hyperkalemia or conditions predisposing to it (adrenal insufficiency, acute dehydration, uncontrolled diabetes mellitus) - for potassium citrate
- Peptic ulcer disease
- Delayed gastric emptying, esophageal compression, or intestinal obstruction (specifically for tablet formulations)
부작용
- Gastrointestinal distress (nausea, vomiting, diarrhea)
- Hyperkalemia (specifically with potassium citrate)
- Fluid retention (specifically with sodium citrate)
- Metabolic alkalosis (rare)
주의
Use with caution (weigh risks vs. benefits) in severe renal tubular acidosis or chronic diarrheal syndromes as they may be ineffective. Sodium citrate products should be used with caution in patients with congestive heart disease due to sodium load. Monitor serum potassium levels closely when using potassium citrate, especially in patients with renal insufficiency.
약물 상호작용
Alkalinized urine can decrease excretion, potentially increasing toxicity.
Alkalinized urine can decrease excretion.
May cause systemic alkalosis. Aluminum-containing antacids may cause aluminum toxicity, especially in renal insufficiency. Sodium bicarbonate combinations may cause hypernatremia.
Alkalinized urine can increase the excretion of salicylates, decreasing their efficacy.
Solubility is decreased in an alkaline environment; monitor for signs of crystalluria.
Alkalinized urine can decrease excretion.
Concurrent use is not recommended as methenamine requires an acidic urine for efficacy.
Alkalinized urine can decrease excretion.
Alkalinized urine can decrease excretion.
May lead to increases in serum potassium levels (hyperkalemia) when used with potassium citrate.
May increase serum potassium levels when used with potassium citrate.
May increase serum potassium levels when used with potassium citrate.
May increase serum potassium levels when used with potassium citrate.
May increase serum potassium levels when used with potassium citrate.
May lead to severe hyperkalemia when used with potassium citrate.
모니터링
- Serum potassium, sodium, bicarbonate, chloride
- Acid/base status
- Urine pH
- Urinalysis (monitor for crystalluria)
- Serum creatinine and CBC (particularly in chronic renal failure)
약동학
흡수
Absorption is nearly complete after oral administration.
대사
Citrate salts are oxidized in the body to bicarbonate. The citric acid component is converted to carbon dioxide and water.
배설
Less than 5% of a dose is excreted unchanged in the urine.
과다투여
Overdosage and acute toxicity generally fall into 4 categories:
- Gastrointestinal distress and ulceration
- Metabolic alkalosis
- Hypernatremia (with sodium citrate)
- Hyperkalemia (with potassium citrate)
Treatment: If an overdose occurs and preventing absorption is reasonable (especially with tablets), employ gut-emptying protocols if not contraindicated. Treat GI effects with intravenous fluids or supportive care. Hyperkalemia, hypernatremia, and metabolic alkalosis should be treated symptomatically. Contact an animal poison control center for specific treatment modalities.
제품
제형
- Granules
- Extended-release oral tablets
- Syrup
- Oral solution
- Crystals for reconstitution
동물용의약품
- Potassium Citrate and Fatty Acids Granules: 300 mg potassium citrate (approx. 2.8 mEq K) per 5 g scoop (Nutrived Potassium Citrate Granules for Cats and Dogs)
인용의약품
- Potassium Citrate Extended-Release Oral Tablets: 5 mEq (540 mg), 10 mEq (1080 mg) & 15 mEq (Urocit-K, generic)
- Potassium Citrate/Sodium Citrate Tablets: 50 mg potassium citrate / 950 mg sodium citrate (Citrolith)
- Potassium Citrate/Sodium Citrate Syrup & Solution: 550 mg K citrate, 500 mg Na citrate, 334 mg citric acid/5 mL (Polycitra, Polycitra-LC)
- Potassium Citrate/Citric Acid Solution: 1100 mg K citrate, 334 mg citric acid/5 mL (Polycitra-K, Cytra-K)
- Potassium Citrate/Citric Acid Crystals for Reconstitution: 3300 mg K citrate, 1002 mg citric acid per packet (Polycitra-K)
- Sodium Citrate/Citric Acid Solutions: 490-500 mg Na citrate, 334-640 mg citric acid/5 mL (Oracit, Bicitra)
- Oral Electrolyte Solution: 20 mEq K, 30 mEq citrate/L (Naturalyte)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store solutions and potassium citrate tablets in tight containers at room temperature unless otherwise recommended by the manufacturer.
보호자 정보
중요: 서방형 정제를 부수거나 반려동물이 씹어 먹게 하지 마십시오. 약물이 너무 빨리 방출되어 위장 자극을 유발할 수 있습니다.
- 투여 방법: 위장 장애를 줄이기 위해 음식과 함께 또는 식후 즉시 투여하십시오. 과립이나 액상 제제인 경우 음식과 잘 섞어 주십시오.
- 수분 공급: 항상 신선한 물을 충분히 마실 수 있도록 해주세요.
- 모니터링: 수의사가 적절하고 안전한 용량을 확인하기 위해 반려동물의 요 pH와 혈액 검사(특히 칼륨 수치)를 정기적으로 실시할 수 있습니다.
- 부작용: 지속적인 구토, 설사, 무기력증 또는 배뇨 습관의 변화가 관찰되면 수의사에게 연락하십시오.
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