title: Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy.
abstract: Calcific uremic arteriolopathy, formerly known as calciphylaxis is a devastating condition that primarily affects patients with end-stage renal disease. The lesions can progress to massive ulcerations of the subcutaneous tissue that are associated with a high degree of morbidity and mortality, usually related to sepsis. Although the pathophysiology of this condition is poorly understood, it appears to be related to a derangement in calcium-phosphate metabolism. Thus, treatments have focused on the treatment of hyperparathyroidism albeit with poor results. More recently, sodium thiosulfate (STS) has emerged as a promising therapy following multiple case reports of marked disease regression following its use. As STS is a strong acid, metabolic acidosis has been described following its administration, although relatively mild in degree. We report a case of a patient with calciphylaxis who repeatedly developed a severe anion gap metabolic acidosis following each dose of STS requiring a significant reduction in the dose.
authors.affiliation: Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA. natalie_selk@rush.edu
authors.forename: Natalie
authors.initials: N
authors.lastname: Selk
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rodby
mesh_terms: D000138:Acidosis / Q000139:chemically induced* / Q000175:diagnosis; D000368:Aged; D001158:Arteries; D002115:Calciphylaxis / Q000150:complications* / Q000188:drug therapy; D002614:Chelating Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D012720:Severity of Illness Index; D013885:Thiosulfates / Q000009:adverse effects* / Q000627:therapeutic use; D014511:Uremia / Q000150:complications / Q000188:drug therapy*; D014652:Vascular Diseases / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D002614:Chelating Agents; D013885:Thiosulfates; C017717:sodium thiosulfate