Hypocitricemic response to surgical stress in rats

The implications of the hypocitricemic response to surgery and the role of liver function and hepatocyte metabolism: An important, but neglected, clinical relationship

“…However, Figure 3 demonstrates the absence of increased clearance and urinary excretion of citrate associated with the surgical hypocitricemia in patients. 5 This was also evident in the animal studies, 6 which revealed no change in the renal clearance of citrate (described below). Consequently, another process must be involved in manifesting the hypocitricemia following surgery; which we addressed in the animal studies.…”

“…Following our initial report 5 that included 30 surgery patients, additional surgery patients were studied; which collectively totaled 65 surgery cases. 6 Of this total, 63 cases exhibited the hypocitricemic response; and in the 2 remaining cases, the patients exhibited a pre-op hypocitricemia of undetermined origin that was sustained following surgery. Therefore, all surgical cases exhibited post-op hypocitricemia; and none of the cases exhibited normocitricemia or hypercitricemia following surgery.…”

“… 5 Since the actions of citricemic hormones (such as parathyroid hormone and calcitonin) are often coupled to their respective calcemic effects, Table 1 shows that hypocalcemia does not correlate with the hypocitricemia; and this is also revealed in the animal studies. 4 , 6 …”

“…Consequently, another process must be involved in manifesting the hypocitricemia following surgery; which we addressed in the animal studies. 6 , 7 …”

“…Table 2 shows the hypocitricemia following laparotomy in rats. 6 A difference between the animal (dog and rat) and the human hypocitricemic response is that the animals return to normocitricemia much more rapidly than humans. This is not due to differences in the surgical procedure since the procedures in the animal studies included splenectomy, venous cut down, and laparotomy; all producing similar hypocitricemic effects.…”