A healthy result should fall into the range 39 - 143 mcg/mg creatinine.

Citric acid, cis-aconitic acid, and isocitric acid are the first three metabolites in the Krebs Citric Acid energy production cycle, which operates in the mitochondria of your cells. 

Citrate, cis-Aconitate (and Isocitrate) are involved in both energy production and removal of toxic ammonia.

High levels can indicate ammonia toxicity. Chronic loss of these valuable compounds can contribute to loss of organ reserve and disturbances in neurological function. If they are low they can indicate a need for essential amino acids, especially arginine.

References:

- Blood metabolomics analysis identifies abnormalities in the citric acid cycle, urea cycle, and amino acid
metabolism in bipolar disorder [https://dash.harvard.edu/bitstream/handle/1/26860076/4832124.pdf?sequence=1]

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