Stone Prevention Fluid Recommendations — ESENeph MCQ
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Correct answer: A — Consider potassium citrate alongside the dietary and fluid measures
The best answer is “Consider potassium citrate alongside the dietary and fluid measures”. NICE recommends considering potassium citrate for adults with recurrent stones that are predominantly calcium oxalate, alongside high water intake, normal dietary calcium and salt restriction. Potassium safety is assessed in CKD. “Eliminate all dietary calcium” is less appropriate because NICE recommends maintaining normal dietary calcium, and restriction may increase oxalate absorption “Begin long-term antibiotics to prevent calcium-oxalate crystallisation” is less appropriate because antibiotics do not prevent recurrent metabolic calcium-oxalate stones “Use a thiazide without establishing hypercalciuria or reducing salt” is less appropriate because NICE reserves thiazide consideration for recurrent predominantly calcium-oxalate stones with hypercalciuria after salt restriction “Replace water with carbonated drinks to increase citrate intake” is less appropriate because NICE recommends water and advises avoiding carbonated drinks
Reference: NICE NG118: renal and ureteric stones: https://www.nice.org.uk/guidance/ng118/chapter/recommendations