檸檬酸鉀
檸檬酸鉀是一種口服鹼化劑，主要用於預防和管理犬貓的**草酸鈣尿結石**。它透過提高尿液pH值並與尿中的鈣結合來發揮作用。 > **臨床提示：** 雖然對預防草酸鈣有效，但不應用於患有鳥糞石的病患，因為鳥糞石在鹼性尿液中容易形成。
作用機制: 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.
給藥途徑
禁忌症
- Renal failure or severe renal impairment
- Hyperkalemia
- Metabolic alkalosis
- Struvite urolithiasis (requires acidic urine)
不良反應
- Gastrointestinal upset (nausea, vomiting, diarrhea)
- Hyperkalemia (rare if renal function is normal)
藥物相互作用
- 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
監測
- Urine pH
- Serum potassium levels
- Renal function (BUN, Creatinine)
- Urinalysis (for crystal formation)
過量
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.
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