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OBJECTIVE: To define a method to prepare Bicitra oral solution for the treatment of excessive Urinary Excretion of the Amino Acid Cystine, Renal Tubular Acidosis, Kidney Stones caused by Cystine, revention of Calcium!Containin" Kidney Stones, Calcium #xalate Kidney Stones$ SCOPE: Sodium Citrate/Citric Acid: (Bicitra Solution) Citric acid and sodium citrate are both al%alini&in" a"ents that ma%e the urine less acidic$ The combination of citric acid and sodium citrate is used to prevent "out or %idney stones, or metabolic acidosis in people 'ith %idney problems$ Renal Tubular Acidosis: Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the %idneys to appropriately acidify the urine$ *hen blood is filtered by the %idney, the filtrate passes throu"h the tubules of the nephron, allo'in" for exchan"e of salts, acid e+uivalents, and other solutes before it drains into the bladder as urine$ The metabolic acidosis that results from RTA may be caused either by failure to recover sufficient (al%aline) bicarbonate ions from the filtrate in the early portion of the nephron (proximal tubule) or by insufficient secretion of (acid) hydro"en ions into the latter portions of the nephron (distal tubule)$ Althou"h a metabolic acidosis also occurs in those 'ith renal insufficiency, the term RTA is reserved for individuals 'ith poor urinary acidification in other'ise 'ell!functionin" %idneys$ Several different types of RTA exist, 'hich all have different syndromes and different causes$ The 'ord acidosis refers to the tendency for RTA to lo'er the blood,s p-$ *hen the blood p- is belo' normal (.$/0), this is called acidemia$ The metabolic acidosis caused by RTA is a normal anion "ap acidosis$ An overvie' of types 1, 2, and 3 is presented belo' (type / is usually excluded from modern classifications)4

T$%e 5ocation Acidosis7 otassium

T$%e ' roximal tubules 8es -ypo%alemia :ailed -C#/= :ailure of -; reabsorption from the athophysiolo"y secretion by the < urine by the proximal intercalated cells tubular cells

T$%e & 6istal tubules 8es (severe) -ypo%alemia

T$%e ( Adrenal 9ild 'hen present -yper%alemia 6eficiency of aldosterone, or a resistance to its effects, (hypoaldosteronism or pseudohypoaldosteronism)

PRESCRIPTIO OR)ER: atient>s name4 A"e4 1 month *ei"ht4 0%" 6ia"nosis4 RTA 6ose4 2mmoles?%"?day 6ispense 13 days supply *ASTER !OR*#"ATIO : Bicitra oral solution contains in each tablespoon full (10ml)4 Sodium citrate dehydrate @ 10AAm" Citric acid monohydrate @ 1AA2m" Each ml contains 1mE+ sodium ions and e+uivalent to 1mE+ bicarbonate ions (-C#/) CA"C#"ATIO : *ei"ht of patient @ 0K" 6ose @ 2mmoles?%"?day 6ose for 0K" patient @ 1Ammoles?0K"?day 6ose for 13 days supply@ 1AB13@ 13A mmoles As 1ml contains 1mE+ sodium ions and 1mE+ bicarbonate ions So 13A mmoles @ 13Aml So, 6ose for 13 days @ 13Aml 6ose for 1 day @ 13A?13@ 1Aml As 'e have to dispense dose four times a day So dose for 1 time is 1A?3 @ 2$20ml *e have to administer the dose as 2$20ml orally after every C hours i$e$ 2$20ml orally + Chrly !or Sodium Citrate )e+$drate: 10ml of preparation contains @ 10AAm" 1ml of preparation contains @ 10AA?10 @ 1AAm" *e have to prepare 13Aml but 'e 'ill prepare sli"htly lar"er as 10Aml$ So, 10Aml of preparation contains @ 1AAB10A@ 10AAA m" or 10 "m !or Citric Acid *ono+$drate:

10ml of preparation contains @ 1AA2m" 1ml of preparation contains @ 1AA2?10 @ CC$Dm" :or 10Aml CC$DB10A@ 1AA2A m"or 1A$A2 "m RE,#IRE*E TS: A%%aratus: 9easurin" cylinder Stirrer Spatula *atch "lass E-ui%ments: *ei"hin" balance C+emicals: Sodium citrate dehydrate @ 10 "m Citric acid monohydrate @ 1A$A2 "m *ater +$s to 10Aml PROCE)#RE: *ash and dry all the apparatus$ *ei"h 10" sodium citrate dehydrate and 1A$A2"m of citric acid monohydrate 'ith the help of 'ei"hin" balance$ Ta%e small amount of 'ater and dissolve both in"redients separately and "radually$ Eo' mix the t'o solutions and then ma%e up the volume up to 10Aml$ our in the appropriate container and label it$ .o/ to use Bicitra oral Sha%e the container 'ell before each dose$ Ta%e this medication by mouth, usually 3 times a day or as directed by your doctor$ To help prevent diarrhea and stomach upset, ta%e each dose after a meal, and mix your prescribed dose of medication in a full "lass (3 to D ounces or 12A to 23A milliliters) of cold 'ater or Fuice Fust before ta%in", or ta%e as directed by your doctor$ 6rin% the entire mixture slo'ly$ The li+uid form of this medication must be mixed 'ith at least 3 ounces (12A milliliters) of 'ater or Fuice before ta%in"$ Refri"eratin" the mixture before drin%in" may improve the taste$ 6osa"e is based on your medical condition and response to treatment$