Sodium Citrate (Bicitra)
Bicitra · Cyclo-Bicitra
Non-particulate oral antacid (citrate buffer)
Citrate is metabolized to bicarbonate → neutralizes gastric acid. NON-PARTICULATE → if aspirated, far less lung injury than particulate antacids.
Indications
- •Aspiration prophylaxis before general anesthesia in high-risk patients (OB, full stomach, GERD) — raises gastric pH quickly
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Aspiration prophylaxis | 15–30 mL PO ~15–30 min before induction | — |
Pharmacokinetics
Onset within minutes; short duration (~30–60 min) → time it close to induction.
Side effects
- !Nausea
- !Metabolic alkalosis (large doses)
Contraindications
- ×Sodium-restricted states (relative)
Clinical pearls
- ★Use the NON-PARTICULATE antacid (citrate) — particulate antacids themselves cause aspiration pneumonitis.
- ★Classic OB/rapid-sequence adjunct: raises gastric pH immediately (unlike H2 blockers/PPIs, which need time). Pair with an H2 blocker + metoclopramide for full prophylaxis.
Other drugs in Electrolytes
- Calcium Chloride
Replaces ionized calcium → restores cardiac contractility, smooth muscle tone, neuromuscular function. Stabilizes cardiac myocyte membrane in hyperK by raising threshold potential.
- Calcium Gluconate
Provides elemental calcium (1 g calcium gluconate = ~93 mg / 4.65 mEq elemental Ca²⁺). One-third the elemental calcium of an equivalent dose of CaCl2 (1 g = 273 mg / 13.6 mEq). Used to treat hypocalcemia, antagonize cardiac membrane effects of hyperkalemia, magnesium toxicity, calcium-channel-blocker overdose.
- Potassium Chloride
Provides K⁺ for replacement of intracellular and serum stores. Maintains resting membrane potential. 1 mEq KCl = 39 mg potassium.
- Sodium Bicarbonate
Provides bicarbonate → buffers H⁺ → raises serum + urine pH. Also drives K⁺ intracellularly.
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Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert