시트르산염 (시트르산 칼륨, 시트르산 나트륨, 시트르산)

요 알칼리화제 / 칼륨 보충제

시트르산염은 수의학에서 주로 **요 알칼리화제**로 사용되며, 만성 신장 질환(CKD)이나 신세관성 산증과 관련된 **만성 대사성 산증**을 관리하는 데 도움을 줍니다. 특히 **시트르산 칼륨**은 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: 1. **Alkalinization**: The resulting alkaline urine increases the solubility of calcium oxalate. 2. **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.

동물 종별 용량

Cats

Adjunctive therapy to inhibit calcium oxalate formation · Initially 50-100 mg/kg PO q12h · PO · q12h · Goal is to achieve a urine pH of approximately 7.5.
Decrease possibility of calcium oxalate stone formation (Nutrived Potassium Citrate Granules) · 1 scoop mixed or sprinkled on food per day · PO · q24h
Adjunctive therapy to inhibit calcium oxalate formation · 100-150 mg/kg/day PO · PO · q24h · It is unclear whether this dose will actually increase urinary citrate in cats.
Adjunctive therapy of chronic renal failure as a potassium supplement and alkalinizing agent · Initially, 75 mg/kg PO q12h · PO · q12h
Significantly acidemic chronic renal failure · 2.5 mEq (total dose) potassium or 15-30 mg/kg as potassium citrate PO q12h · PO · q12h
Hypokalemic chronic renal failure · 2-4 mEq (total dose) of potassium per day as potassium citrate or potassium gluconate · PO · q24h

Dogs

Adjunctive therapy to inhibit calcium oxalate crystal formation (hypocitraturia) · 40-75 mg/kg PO q12h · PO · q12h · Avoid overzealous urinary alkalinization as calcium phosphate uroliths may form.
Adjunctive therapy to inhibit calcium oxalate crystal formation · Initially 50 mg/kg PO q12h · PO · q12h · Monitor urine pH; goal is to obtain values of 7-7.5.
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

투여 경로

금기

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)

이상반응

Gastrointestinal distress (nausea, vomiting, diarrhea)
Hyperkalemia (specifically with potassium citrate)
Fluid retention (specifically with sodium citrate)
Metabolic alkalosis (rare)

약물 상호작용

Amphetamines · Alkalinized urine can decrease excretion, potentially increasing toxicity.
Pseudoephedrine / Ephedrine · Alkalinized urine can decrease excretion.
Antacids · May cause systemic alkalosis. Aluminum-containing antacids may cause aluminum toxicity, especially in renal insufficiency. Sodium bicarbonate combinations may cause hypernatremia.
Aspirin (Salicylates) · Alkalinized urine can increase the excretion of salicylates, decreasing their efficacy.
Fluoroquinolones (e.g., ciprofloxacin, enrofloxacin) · Solubility is decreased in an alkaline environment; monitor for signs of crystalluria.
Lithium · Alkalinized urine can decrease excretion.
Methenamine · Concurrent use is not recommended as methenamine requires an acidic urine for efficacy.
Quinidine · Alkalinized urine can decrease excretion.
Tetracyclines · Alkalinized urine can decrease excretion.
ACE Inhibitors (e.g., enalapril, lisinopril) · May lead to increases in serum potassium levels (hyperkalemia) when used with potassium citrate.
Cyclosporine · May increase serum potassium levels when used with potassium citrate.
Digoxin · May increase serum potassium levels 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)

과용량

Overdosage and acute toxicity generally fall into 4 categories: 1. **Gastrointestinal distress and ulceration** 2. **Metabolic alkalosis** 3. **Hypernatremia** (with sodium citrate) 4. **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.

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