Severe anion gap acidosis associated with intravenous sodium thiosulfate administration

J Med Toxicol. 2013 Sep;9(3):274-7. doi: 10.1007/s13181-013-0305-z.

Abstract

Introduction: Severe anion gap (AG) acidosis associated with intravenous sodium thiosulfate (STS) administration has not been previously described in nondialysis chronic kidney disease (CKD) patients.

Case report: We present a CKD patient with a baseline creatinine 1.8 mg/dL (eGFR 28 ml/min/1.73 m²) who developed sustained and life-threatening AG acidosis associated with intravenous STS treatment for calciphylaxis.

Discussion: Although marketed as a safe drug, STS can cause life-threatening acidosis as illustrated in this case. STS-induced AG acidosis should be considered in the differential diagnosis of severe acidosis in patients receiving STS. Dosage adjustment and close follow-up of patients' acid-base status after STS initiation is necessary.

Publication types

  • Case Reports

MeSH terms

  • Acidosis, Renal Tubular / chemically induced*
  • Acidosis, Renal Tubular / complications
  • Acidosis, Renal Tubular / physiopathology
  • Acidosis, Renal Tubular / therapy
  • Aged
  • Antioxidants / administration & dosage
  • Antioxidants / adverse effects*
  • Antioxidants / pharmacokinetics
  • Antioxidants / therapeutic use
  • Calciphylaxis / blood
  • Calciphylaxis / etiology
  • Calciphylaxis / physiopathology
  • Calciphylaxis / therapy*
  • Critical Care
  • Female
  • Heart Arrest / complications
  • Heart Arrest / etiology
  • Heart Arrest / prevention & control
  • Heart Arrest / therapy
  • Hospices
  • Humans
  • Infusions, Intravenous
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy
  • Leg
  • Renal Dialysis
  • Secondary Prevention
  • Severity of Illness Index
  • Thiosulfates / administration & dosage
  • Thiosulfates / adverse effects*
  • Thiosulfates / pharmacokinetics
  • Thiosulfates / therapeutic use
  • Treatment Refusal

Substances

  • Antioxidants
  • Thiosulfates
  • sodium thiosulfate