THE OCCURRENCE OF CITRIC ACID IN URINE AND BODY FLUIDS

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Abstract
A study of the citric acid content of the urine of more than 300 patients, including the data of Ostberg, has not revealed any practical clinical significance. Usually the administration of large amounts of citric acid does not increase the amount excreted in the urine. Administration of physiologically strong base, e.g., NaHCO3, usually increases the output from the average normal 0.5 gm. to about 2 gm. daily; strong acid, such as HCl (CaCl2 or NH4Cl) decreases or stops it; moderate ketosis may or may not do so. Citric acid is present only in small amounts, or not at all, in the severe acidosis of diabetic coma. The evidence does not warrant the conclusion that the chief metabolic function of citric acid is to maintain acid-base balance. Citric acid must play some important, although as yet an unknown, part in the intermediate steps of metabolism, due to its wide distribution in the various body fluids: blood, spinal fluid, amniotic fluid, spermatic fluid, aqueous humor of the eye, milk and urine. It does not necessarily arise from ingested citric acid or carbohydrate food, for in the dog the amount increases throughout a prolonged fast. It is also excreted in increased amounts after removal of the livers of dogs, but the amount is usually not significantly altered by removal of the suprarenal glands.

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