Can disodium citrate be used to treat burning micturition (dysuria)?

Disodium Citrate for Burning Micturition (Dysuria)

Disodium citrate can be effective in treating burning micturition (dysuria), particularly when the symptoms are related to urinary tract irritation without clear bacterial infection. 1

Mechanism of Action and Benefits

• Sodium citrate (including disodium citrate) creates an osmotic imbalance that brings water into the large bowel to soften stool and stimulates the bowel to contract, but in the urinary tract, it works by alkalinizing the urine 2
• Citrate therapy provides an alkali load that leads to increased urine pH, which can reduce irritation of the urinary tract mucosa 2
• In patients with cystitis symptoms without clear bacterial infection, sodium citrate can provide good symptomatic relief in approximately 80% of cases 1

Indications for Citrate Use in Urinary Symptoms

• Burning micturition without evidence of bacterial infection 1
• Dysuria associated with acidic urine 2, 3
• Overactive bladder symptoms, which often coincide with burning micturition 4

Clinical Evidence

• A clinical study showed that a 48-hour course of sodium citrate provided significant symptom relief for women with cystitis symptoms without definitive bacterial infection 1
• Potassium citrate (a related compound) has been shown to significantly decrease overactive bladder symptoms, which often include dysuria 4
• Citrate increases urinary pH, which can reduce irritation of the urinary tract epithelium 3, 5

Important Considerations and Contraindications

• Sodium citrate should not be used in cases with confirmed urinary tract infection, as these require appropriate antibiotic therapy 1, 3
• Citrate therapy is contraindicated in:
  • Urinary tract infections (requires antibiotics instead) 3
  • Struvite renal stone disease 3
  • Advanced chronic renal failure 3
  • Metabolic alkalosis 3

Algorithm for Use in Burning Micturition

1. Confirm absence of bacterial infection:

   • Perform urinalysis and urine culture to rule out bacterial infection 6
   • If infection is present, treat with appropriate antibiotics instead of citrate

2. Consider citrate therapy when:

   • Dysuria is present without bacteriuria 1
   • Urine pH is low (acidic) 3, 5

3. Dosing and administration:

   • Typically administered as a 48-hour course for symptomatic relief 1
   • Potassium citrate is generally preferred over sodium citrate for long-term use due to lower risk of increasing urinary calcium excretion 2, 3

4. Monitoring:

   • If symptoms do not improve after 48 hours, bacterial infection should be suspected and antibiotic therapy considered 1
   • Monitor urine pH to ensure appropriate alkalinization 3

Common Pitfalls and Caveats

• Failure to respond to citrate therapy is suggestive of bacterial infection requiring antibiotics 1
• Sodium citrate may increase urinary calcium excretion, which could potentially promote stone formation in susceptible individuals 2
• Using citrate without ruling out infection may delay appropriate antibiotic treatment 6, 1
• Potassium citrate is generally preferred over sodium citrate for long-term use in patients with recurrent symptoms 2