Bicitra

We do not dilute, although I sometimes pour it over ice, I think it is more palatable cold. I tell people to be prepared for the taste, like liquid sweet tarts...

We do leave it in the fridge, but other than that we don't dilute it or mix with anything.

Methinks RedCell was yanking some chains.

We knock our Bicitra straight back.

I've had Bicitra before every one of my surgeries, and it is NASTY. But it's like anything else, you take it straight up and toss it back, and it's over with in a second. Dilute it in juice or water and you're defeating the purpose of being NPO, which is unnecessarily risky IMO.

There are different preparations (tablets, solution or crystals) doses and preparation depending if one is using to decrease citrate content to prevent kidney stones or to decrease PH content prior to surgery (to prevent aspiration pneumonia).

For patients taking the tablet form of this medicine :

• Swallow the tablets whole. Do not crush, chew, or suck the tablet. Take with a full glass (8 ounces) of water.
  
• If you have trouble swallowing the tablets or they seem to stick in your throat, check with your doctor at once . If this medicine is not completely swallowed and not properly dissolved, it can cause severe irritation.
  

For patients taking the liquid form of this medicine :

• Dilute with a full glass (6 ounces) of water or juice and drink; follow with additional water, if desired.
  
• Chill, but do not freeze, this medicine before taking it, for a better taste.
  

For patients taking the crystals form of this medicine :

• Add the contents of one packet to at least 6 ounces of cool water or juice. Stir well to make sure the crystals are completely dissolved.
  
• Drink all the mixture to be sure you are taking the correct dose. Follow with additional water or juice, if desired.
  

Take each dose immediately after a meal or within 30 minutes after a meal or bedtime snack . This helps prevent the medicine from causing stomach pain or a laxative effect...

For sodium citrate and citric acid

• For oral dosage form (solution):
  
  • o make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    
    • Adults—At first, 2 to 6 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed. However, most people will usually not take more than five ounces a day.
      

    [*]To make the contents of the stomach less acidic before surgery:

    • Adults—1 to 2 tablespoonfuls as a single dose. You may mix it in one to two tablespoonfuls of water.
      

    [*]To make the blood more alkaline (less acidic):

    • Children—At first, 1 to 3 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed.
      

http://www.drugs.com/cons/bicitra.html

There are different preparations (tablets, solution or crystals) doses and preparation depending if one is using to decrease citrate content to prevent kidney stones or to decrease PH content prior to surgery (to prevent aspiration pneumonia).

For preop preparation there is only one acceptable dosage range: 15-30cc po. The whole idea is to prevent mendelson's syndrome/aspiration pneumonia. The two most important aspects for risk in aspiration pneumonia are having greater than 25cc in the stomach and having a pH less than 2.5. Giving more than 30cc of bicitra and some would say more than 15cc increases the risk of apsiration and there are a lot of anesthesia providers that would delay the surgery or possibly cancel the surgery depending on how much dilutent was used.

Try these references for more information:

Clinical Anesthesiology: Morgan et al.

Basics of Anesthesia: Stoelting

http://books.google.com/books?id=YgP11R7IKOsC&pg=PA279&lpg=PA279&dq=bicitra+anesthesia&source=bl&ots=_ANWsbfjmd&sig=0fqP_rWy8wtqbUToxZ6qQRxNJXA&hl=en&ei=QsuHSqfqCKCntgeWgNnnDA&sa=X&oi=book_result&ct=result&resnum=4#v=onepage&q=bicitra%20anesthesia&f=false