5 Supplementation in this range is associated with an approximately 2-times Supplementation with potassium citrate 30 to 40 mEq/day is a preventative strategy. References citrate content at 6.8 mEq citrate per liter, 4 while another using nuclear magnetic resonance spectroscopy references it atįor patients with calcium oxalate stones and suspected or confirmed hypocitraturia, Different citations and biochemical techniques 3 In our case, the patient developed recurrent kidney stones followingĬessation of about 1.4 L/day of DMD. 2 Hypocitraturia has been classified as less than 320 mg excreted per day. Urineīiochemical abnormalities may include hypercalciuria, hyperoxaluria, hypocitraturia, Modifiable risk factors include lowĭietary intake of calcium, potassium, and fluids and high intake of oxalate-richįoods, non-dairy animal protein, and vitamin C supplements, among others. Highest prevalence in white, elderly men. Stone analysis showed calcium oxalate stones.Ĭalcium oxalate stones are the most common type of kidney stones (70%-80%), with the Was discharged home and approximately 2 weeks later underwent outpatient Patient’s pain and creatinine improved to 1.9 g/dL and QTc improved to 411 ms. Send-out test was not sent during his admission. A 24-hour urine citrate was not available at our institution, and a (reference 16-49 mg/day) and low urine calcium 0.05 g/volume (reference 0.1-0.3 Biochemical urine studies showed normal urine oxalate at 26 mg/day Urology was consulted, and bilateral ureteral stents Repeat CT stone protocol showed an obstructing left mid-ureteral 7-mmĬalculus with mild upstream hydroureter ( Figure 1) and 2 adjacent nonobstructing 2-mmĭistal right ureteral calculi. On admission, the patient was afebrile with blood pressure 142/85 mm Hg, pulse 69īpm, respiratory rate 16, and O2 sat 98% on room air. Was directed to the emergency department for admission. Dofetilide and apixaban were stopped, and he Was found to have an elevated Cr 2.99 g/dL (baseline ~ 1.3 g/dL) and an increase in Office for a routine follow-up of atrial fibrillation controlled with dofetilide. On the day of admission, he was seen in his cardiologist’s Unfortunately, the stone was not passed, and the patient continued toĮxperience flank pain. Treatment was again initiated with increased oral hydration, tamsulosin, and TheĬT stone protocol showed a nonobstructing 5-mm stone in the proximal left ureter andĪ 4-mm stone in the right ureter with minimal hydronephrosis. Two weeks prior to admission, the patient developed acute left-sided flank pain. Nephrolithiasis analysis was ordered, but the patient did not return his passed Increased oral hydration, tamsulosin 0.4 mg daily, and oxycodone for pain control. Nonobstructing left upper pole renal calculus. Ureterovesicular junction with associated right hydroureteronephrosis and a 5-mm To his primary care provider’s office after acute onset of severe right flank pain.Ĭomputed tomography (CT) stone protocol showed a 6-mm calculus at the right After this diagnosis, he eliminated all Diet Mountain Dew (DMD)Ĭonsumption from his diet (average of four 12-ounce cans or about 1.4 L of DMD perĭay) and replaced it with water hydration. Four months prior to admission, the patient received a newĭiagnosis of DM. He was found to have acute kidney injury due to Supplemental choice must be considered for every patient.Ī 62-year-old man with a past medical history of atrial fibrillation and recentlyĭiagnosed with type II diabetes mellitus (DM) presented to our institution withĪcute left-sided flank pain. Patient lifestyle and the risks and benefits to a particular Light), and natural juices (eg, lemon juice), may be plausible alternatives to Alternative supplementation strategies, such asĬitrus-flavored sodas (eg, Diet Mountain Dew), powdered drinks (eg, Crystal Citrate binds calcium, therefore, preventing the interactionīetween calcium and oxalate. Strategy against calcium oxalate stones in patients with suspected or confirmed Patient’s nephrolithiasis has not recurred. In citrate-instead of potassium citrate 30-40 mEq supplementation. Preference, the patient chose lemonade-flavored Crystal Light-known to be high Protective against his newly recurrent nephrolithiasis. It was theorized that the high citrate in Diet Mountain Dew was A 62-year-old man with a past medical history of recently diagnosed type IIĭiabetes mellitus presented for multiple episodes of nephrolithiasis after
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