Would you start potassium citrate for a patient with normal urine citrate levels, but who suffers from recurrent calcium oxalate nephrolithiasis and no identifiable risk factors on 24 hour urine studies, as a method of increasing urine citrate levels to further prevent stone formation?

No. I am not aware of data that raising urinary citrate levels above normal is helpful in the prevention of calcium-based kidney stones.

My next step would be to encourage the patient to improve dietary and fluid consumption compliance.

If the patient cannot comply, my last option would be to go to ...

There is no data that I am aware of that further increasing urinary citrate will prevent calcium oxalate stones, thus would encourage the patient to make sure to take in adequate volume and watch oxalate intake.