Sodium citrate is a cheap salt the body turns into a base, lowering acidity in blood and urine. It cuts calcium kidney stone recurrence, though a potassium form is often better. As an exercise aid its benefit is small and mixed. Its heavy salt load can upset the stomach, raise blood pressure, and is unsafe with kidney or heart disease. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Serum bicarbonate (CO₂) | 24–28 mmol/L | Tracks acid-base status and buffering response |
| Blood pressure | <120/80 mmHg | Detects sodium-driven rises |
| Serum sodium | 135–142 mmol/L | Flags sodium overload or high blood sodium |
| Serum potassium | 4.0–4.5 mmol/L | Baseline safety before alkali therapy |
| eGFR / creatinine | eGFR >90 mL/min/1.73 m² | Confirms kidneys can clear the sodium and citrate load |
| Urinary pH | 6.0–6.5 (stone prevention) | Confirms alkalinization without overshooting |
| 24-hour urinary citrate | >640 mg/day | Confirms correction of low urinary citrate |
Cadence: Recheck labs and blood pressure 4–8 weeks after starting or changing dose, then every 6–12 months (more often in older adults or reduced kidney function); stone formers reassess 24-hour urine chemistry at 8–12 weeks.