From the Guidelines
Citric acid has a positive effect on the body, providing energy and bicarbonate without requiring insulin to enter cells.
Key Effects of Citric Acid
- Citrate, an intermediate metabolite of the Krebs cycle, can be metabolized yielding energy and bicarbonate 1
- The energy gain from citrate can be substantial, depending on the type and rate of fluids used, with reports of up to 1300 kcal/d using high lactate replacement fluids and anticoagulation with ACD-A 1
- Citrate is partially removed from the blood by kidney replacement therapy (KRT), and the citrate load to the patients depends on the balance between the total dose administered and the amount of citrate removed through the filter during KRT 1
Clinical Implications
- For patients undergoing KRT, the total energy provision by additional calories given in the form of citrate, lactate, and glucose from dialysis/hemofiltration solutions should be included in the calculations to determine the total daily energy provision to avoid overfeeding 1
- Citrate can be used as a pharmacologic agent to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones, particularly for patients with calcium stones 1
Important Considerations
- The energy gain from citrate can vary widely depending on the lactate content of replacement fluids and type of anticoagulation, ranging from 115-1300 kcal/d 1
- Citrate is metabolized primarily in the liver, as well as in the kidney and skeletal muscle, and does not require insulin to enter cells 1
From the Research
Physiological Effects of Citric Acid
- Citric acid has been found to regulate blood lipid levels in hyperlipidemic rats, reduce resistance induced by hyperlipidemia, and improve insulin sensitivity 2.
- The citric acid cycle is a crucial metabolic pathway that supplies energy to the body, connecting almost all individual metabolic pathways 3.
- Citric acid has been used as a pharmaceutical excipient due to its biocompatibility, versatility, and environmentally friendly chemistry, with its functionality allowing it to be used in various applications 4.
Antioxidant and Anti-Inflammatory Effects
- Citric acid has been shown to attenuate lipopolysaccharide-induced oxidative stress in the brain and liver of mice, reducing lipid peroxidation and inflammation 5.
- The administration of citric acid has been found to decrease brain lipid peroxidation and inflammation, liver damage, and DNA fragmentation in a model of systemic inflammation 5.
Respiratory Effects
- Citric acid has been used to induce cough in both healthy volunteers and patients with chronic cough, with the pH of the solution playing a role in the induction of cough 6.
- The response to citric acid cough challenge has been found to vary between healthy volunteers and patients with chronic cough, with chronic cough patients coughing more than healthy volunteers and not exhibiting a clear pH concentration response 6.