Potassium Citrate

How it works

It is metabolised to bicarbonate, which raises urinary pH, increasing the solubility of uric acid and cystine and reducing the tendency to crystallise; it also provides a potassium load.

Prescribing in practice

• It is hazardous in renal impairment and in patients taking other agents that raise serum potassium, as it can precipitate dangerous hyperkalaemia.
• Avoid concurrent use with potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers without close electrolyte monitoring.
• It should be well diluted in water before administration to reduce gastrointestinal irritation.

Monitoring

Monitor serum potassium and renal function, particularly in those with impaired renal function or on interacting medicines.

Counselling the patient

• Always dilute the medicine well in water before drinking it.
• Report muscle weakness, palpitations or tingling, which may indicate a high potassium level.

Evidence & guidelines

Urinary alkalinisation is an established adjunct in selected stone disease; see the SPC and current prescribing references for indications and monitoring.