The risk or severity of bleeding and hemorrhage can be increased when Aceclofenac is combined with Sodium citrate. The risk or severity of bleeding can be increased when Abciximab is combined with Sodium citrate. Largely eliminated through hepatic metabolism with very little cleared by the kidneys 3 4. Volume of distributionĬitrate is metabolized to bicarbonate in the liver and plays a role as an intermediate in the citric acid cycle 5 9. It also acts as a diuretic and increases the urinary excretion of calcium. It it further metabolized to bicarbonate which then acts as a systemic alkalizing agent, raising the pH of the blood and urine 8. Citrate is a weak base and so reacts with hydrochloric acid in the stomach to raise the pH. Citrate may also exert an anticoagulant effect via a so far unknown mechanism as restoration of calcium concentration does not fully reverse the effect of citrate 1. This inhibits the extrinsic initiation of the coagulation cascade. Mechanism of actionĬitrate chelates free calcium ions preventing them from forming a complex with tissue factor and coagulation factor VIIa to promote the activation of coagulation factor X 1 2. Citrate neutralizes acid in the stomach and urine, raising the pH 8. Citrate prevents activation of the clotting cascade by chelating calcium ions.
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