Well, there's potassium and there's citrate. That's what it is, right? And so our body naturally has these things, so basically it is a supplement.
But you should be getting yours from the pharmacy, meaning I don't want people to just go get potassium citrate cause there are forms of it on the shelf in the drugstore. You should be getting an order, a prescription from your doctor, please. Don't be just taking potassium citrate, and we'll be talking about that later.
But it can be very helpful in kidney stone disease, very helpful. If you make uric acid stones, potassium citrate can help dissolve those stones, 100%. So, there are uric acid stones, I want to be clear right up front because people will tell me, "Jill, I did this.
I sucked on this. I waved three times and ran down the street naked and my stone dissolved." Poof! Didn't happen, unless you make uric acid stones.
Uric acid stones are the only stones that can be dissolved. Their makeup is such that they can be dissolved, and lots of times potassium citrate will be ordered to help that process. There's that.
So, yes, they can help dissolve the kidney stone if you make uric acid stone. Otherwise, no other stone's going to be dissolved by them. Potassium citrate is used for patients that have lower citrate levels and it has to be bound with something, so potassium citrate or magnesium citrate or different forms of citrate.
And so potassium citrate is what this citrate, potassium is bound with citrate, and it's helpful for kidney stone formers because, yes, if you make uric acid stones, they can help make them smaller, but also if patients have low citrate, the only way you will know if you have this is by doing a 24-hour urine collection, so please get them done.
You know I beg you guys to get those done. You must get them done. If your doctor doesn't order, push again or find a doctor that will, because your primary can order it, your gyne can order it, anybody can order a 20- any doctor can order a 24-hour urine collection.
So, get that order to see if you will benefit from it. So, patients who have low citrate or, and a low urine pH will be put on potassium citrate. What does this do?
I'm going to give you the Jill version as I always do, cause it's simple. Citrate is a molecule in our body, and we know that it in kidney stone disease, it surrounds itself around calcium in the urine. It acts like a little knight in shining armor or queen in shining armor, whatever, and it protects calcium by binding with her, surrounding her like a shield so oxalate and other crystals cannot combine with her.
If your citrate is low, calcium can't be protected and that's a problem, and so you have a higher risk of kidney stones. Potassium citrate will also increase your pH. My diabetic patients who come with me with kidney stones have a lower pH because of their disease, diabetes.
So, they will be put on potassium citrate. The doctor could also say, "Listen, Irene, eat some more fruits and vegetables cause that will get your pH up." And that's very true. So, when I'm dealing with a urine collection result, I'll say, "Irene, you can naturally get this pH up if you eat more fruits and vegetables." But because everybody's petrified of oxalate, they start lowering their fruit and vegetable intake.
Now, their citrate's going down. Now, their pH is going down, and now they can form another type of stone, a uric acid stone or and a calcium oxalate stone. So, we want your pH to be more alkaline.
If it's running acidic, and there's certain medical conditions that will have you run acidic: diabetes, bowel disease, bariatric surgeries, malabsorption issues overall. So, if that's happening to you, a potassium citrate may be prescribed. If you have high urine calcium, potassium citrate may be prescribed.
Again, it will protect that excess calcium so these other crystals can't join with her. Calcium is always a girl to me. Don't ask me why.
Just go with it, people. Potassium citrate is also used when people are put on thiazides, which are a class of medications that are used in kidney stone disease to lower urine calcium. When they're put on these thiazides, their citrate can be lowered because of that, so then they're automatically put on potassium citrate.
So, potassium citrate in general, there's different reasons it's ordered, but it's ordered always because somebody is having issues with low citrate or and a low urine pH, and also, perhaps a high urine calcium. So, that's why potassium citrate will be ordered. Now, why I don't want you to take this, just go into your Duane Reade if you're in the East Coast or the Midwest Walgreens, I don't want you going over and finding a no potassium citrate, folks, because if you have not done a urine collection, you may have a very high urine pH and that's another reason you make a different kind of stone called calcium phosphate stones.
So, you're going to maybe if I don't say this in the video, you're going to be like, "Bobby, she said potassium citrate can shrink a uric acid stone. I don't know what kind I make, but I'm going to take a chance and let's do that." Or it seems like it has a lot of benefits, so let's just take it. We won't tell her, but let's just take it.
Here's the problem with that: if you haven't done a urine collection and you have a high urine pH and now you're taking something that's going to increase your pH even more, you're now putting your risk higher for calcium phosphate stone. And, guys, those stones grow faster and larger. Don't mess with this.
And, also, potassium citrate, the number one side effect from it, which a lot of my patients suffer from, is gast- is stomach upset, either too acidic or they just have upset stomach, diarrhea is very common. So, it's very important you just don't take this. Here's another thing.
Sometimes I notice, as a nurse I never override a doctor's order, of course, but sometimes my job is to educate a patient so they can have better conversations with their doctor. Here's a common scenario. A patient comes to me and now they're doing their follow-up urine collection with me, and they're on a really high dose of potassium citrate because, originally, they were given it, okay, when they got their first urine collection, their citrate was low, their pH is low, but they had a consult with me and I told them, "You can also increase your citrate and pH through vegetables." "Oh, okay, Jill.
I didn't know that. And fruits." "Okay, I was so afraid because of oxalate, but, okay, I'll do that." So, now they do a follow-up and they call me to go over that, and their citrate looks really great and now their pH is getting a little bit too high, 6.5, 6.6, 7. Don't listen to all the marketing bull, you folks, on stupid alkaline waters and stuff.
You may be spending a lot of money and you don't need that, especially if you have a high urine pH. Going to put you more at risk for a different kidney stone type. So, now, you've changed your diet, which is awesome.
You're eating more fruits and vegetables, but you're still on that same damn really high dose of potassium citrate. I'm going to tell the patient to when the doctor goes over this urine collection, the follow-up with them, ask them, "Dear Doctor, you can see my pH and citrate are great. As a matter of fact, my pH is getting now too high because I have upped my fruits and vegetables.
Can I lower the potassium citrate dose?" Every doctor always says yes. They're thrilled to see the patient incorporate more fruits and vegetables, and they're thrilled to lower the dose. So, these are some of the values.
There's many. I don't toot my own horn about a lot of shit cuz I'm a mess in a lot of areas, but this stuff, guys, I got you. This, being a mother, a loving person, got you.
Everything else I'm kind of all over the place. Jeff would tell you, "She is, she is, she's not very organized." I'm not, I'm not. Don't care about that.
I won't be on my deathbed saying, "Shit, I wish I did a better job with organization." I won't. I care about what I care about. And so what I'm telling you is eating more fruits and vegetables can naturally raise your pH and citrate.
I always like a patient to start there before pills are involved. Potassium citrate is expensive and those pills are known around the kidney stone world as horse pills. They're very large and for seniors like me and older, it's going to be very difficult to swallow them.
So, I want to wrap this up. Are they beneficial in kidney stone disease, potassium citrate? Absolutely.
Can potassium citrate what do you say, Jeff, when you're making the stone smaller?
