Category: Clinical Stones: Medical Management
Introduction & Objective : Potassium citrate has been adopted as the mainstay therapy for recurrent stone formers with hypocitraturia and aciduria. Gastrointestinal side effects, large pill size, and frequent dosing of the medication has limited patient compliance. Orange juice (OJ) has been suggested as a dietary alternative potassium citrate, but high sugar content is regarded as a major shortcoming. Low calorie orange juice (low-cal OJ) beverages are a newer product with fifty percent less carbohydrates. The goal of our study was to assess the available citrate and alkali content of every-day citrus beverages, including low calorie options.
Methods : Citrate and malate content of the beverages were measured by ion chromatography. The alkali content of the beverages was calculated from the pH of the beverage, the concentrations of malate and citrate, and the pKs of the organic anions. Preliminary clinical data was obtained using Litholink laboratories after a single volunteer consumed 2L of water, crystal light, and low-cal OJ.
Results of the chemical analysis are represented in Table 1. We found that low-cal OJ has comparable concentrations of citrate (range: 37.1-45.2 mmol/L versus 42.6-42.8) and alkali (range 47.9-57.6 mmol/L versus 56.4-63.5) to standard orange juice. When low-cal OJ was consumed for 7 days urine volume (2.95 vs 1.66 L/day), urinary citrate (1163 vs 644 mg/day) and urinary pH (6.92 vs 5.94) all increased compared to water-control.
Conclusions: Low-cal OJ appears to have clinical application for aciduria and hypocitraturia. Further studies are on-going to evaluate the reproducibility of these findings and the feasibility in patients with recurrent stone disease, aciduria and hypocitraturia.
Tim Large– Endourology Fellow, Indiana University School of Medicine, Indianapolis, Indiana
Williams James– Professor, Indiana School of Medicine, Indianapolis, Indiana
John Asplin– Medical Director, Litholink Corporation, Chicago, Illinois
Amy Krambeck– Professor, Indiana University School of Medicine, Indianapolis, Indiana
Indiana University School of Medicine
Name: Tim Large MD
Title: Endourology Fellow - Indiana University School of Medicine
Affiliation: IU-Methodist Hospital
I am currently in the second year of fellowship with Drs. Lingeman and Krambeck at Indiana University in Indianapolis, Indiana. We focus on the management of stones and symptomatic benign prostate hyperplasia.