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Original ArticleOpen Access
The Optimal Dose of Potassium Citrate in the Treatment of Children with Distal Renal Tubular Acidosis
Tapaneya-Olarn W 
,
Khositseth S ,
Tapaneya-Olarn C ,
Teerakamjana N ,
Chaichawajaremkul U ,
Stitchantrakul W ,
Petchthong T
,
Khositseth S ,
Tapaneya-Olarn C ,
Teerakamjana N ,
Chaichawajaremkul U ,
Stitchantrakul W ,
Petchthong T Background : Distal renal tubular acidosis (RTA) is a common cause of intractable calcium
nephrolithiasis. In adults, the use of potassium citrate (PC) in distal RTA effectively decreases
metabolic acidosis and the risk of calcium oxalate stone but it cannot decrease the risk of calcium
phosphate stone. However, there is no report for the optimal dose of PC and the risk of calcium stone
in distal RT A in children.
Objective : To evaluate the optimal dose of PC that minimizes the risk of calcium nephrolithiasis
in children with distal RT A.
Method : Prospective study
Patients : Children who have distal RT A and were followed-up for 4 months. Patients
were studied in a control phase, 1 month of PC 2 mEq/kg/day, 2 months of PC 3 mEq/kg/day and 1
month of PC 4 mEq/kg/day. The urine specimens of 41 normal children were measured for the
reference value of the parameters determining the risk of calcium stone.
Results: Eight children (mean age of 10 ± 3.7 years, female: male= 6: 2) with distal RTA
were studied during the control phase and after receiving PC 2 mEq/kg/day for 1 month. Treatment
with PC 2 mEq/kg/day was not able to normalize serum bicarbonate and caused no significant
change in the urine citrate/creatinine ratio, and activity production of calcium phosphate stone but
it caused a significant decrease in the urine calcium/citrate ratio.
Although PC 3 mEq/kg/day for 1 month normalized plasma bicarbonate, only this dose
given for 2 months caused a significant increase in the urine citrate/creatinine ratio and urine calcium/
citrate ratio to values that were not different from normal children, while the activity production of
calcium phosphate stone did not decrease to normal level. The effect of PC 4 mEq/kg/day was similar
to that of 3 mEq/kg/day.
Conclusion : Potassium citrate 3 mEq/kg/day for 2 months effectively normalized serum
bicarbonate and decreased the risk of calcium oxalate stone but this treatment was theoretically
unable to reduce the risk of calcium phosphate stone in children with distal RT A.
Key word : Potassium Citrate, Distal Renal Tubular Acidosis
nephrolithiasis. In adults, the use of potassium citrate (PC) in distal RTA effectively decreases
metabolic acidosis and the risk of calcium oxalate stone but it cannot decrease the risk of calcium
phosphate stone. However, there is no report for the optimal dose of PC and the risk of calcium stone
in distal RT A in children.
Objective : To evaluate the optimal dose of PC that minimizes the risk of calcium nephrolithiasis
in children with distal RT A.
Method : Prospective study
Patients : Children who have distal RT A and were followed-up for 4 months. Patients
were studied in a control phase, 1 month of PC 2 mEq/kg/day, 2 months of PC 3 mEq/kg/day and 1
month of PC 4 mEq/kg/day. The urine specimens of 41 normal children were measured for the
reference value of the parameters determining the risk of calcium stone.
Results: Eight children (mean age of 10 ± 3.7 years, female: male= 6: 2) with distal RTA
were studied during the control phase and after receiving PC 2 mEq/kg/day for 1 month. Treatment
with PC 2 mEq/kg/day was not able to normalize serum bicarbonate and caused no significant
change in the urine citrate/creatinine ratio, and activity production of calcium phosphate stone but
it caused a significant decrease in the urine calcium/citrate ratio.
Although PC 3 mEq/kg/day for 1 month normalized plasma bicarbonate, only this dose
given for 2 months caused a significant increase in the urine citrate/creatinine ratio and urine calcium/
citrate ratio to values that were not different from normal children, while the activity production of
calcium phosphate stone did not decrease to normal level. The effect of PC 4 mEq/kg/day was similar
to that of 3 mEq/kg/day.
Conclusion : Potassium citrate 3 mEq/kg/day for 2 months effectively normalized serum
bicarbonate and decreased the risk of calcium oxalate stone but this treatment was theoretically
unable to reduce the risk of calcium phosphate stone in children with distal RT A.
Key word : Potassium Citrate, Distal Renal Tubular Acidosis
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