Would you avoid starting potassium citrate in a patient with recurrent calcium oxalate nephrolithiasis and hypocitraturia if they have metabolic alkalosis?

If the metabolic alkalosis was from hypokalemia and/or thiazide, as is common in stone formers, I would not hesitate, as the potassium would be beneficial in reducing the excess renal ammonia excretion. If from other causes, everything would depend on the cause.

I don’t remember encountering this situation before. At least theoretically, potassium citrate would aggravate the metabolic alkalosis. I would certainly look for the cause of the alkalosis and correct it if possible. Chronic vomiting is a possible cause and would also decrease urine volume and aggr...

In short, I would avoid using potassium citrate in a patient with metabolic alkalosis and hypocitraturia. There are nominally neutral citrate supplements, including over-the-counter drugs such as Moonstone/Stone Stopper, that can be used to supplement citrate without contributing to metabolic alkalo...