title: Severe anion gap acidosis associated with intravenous sodium thiosulfate administration.
abstract: BACKGROUND
  Severe anion gap (AG) acidosis associated with intravenous sodium thiosulfate (STS) administration has not been previously described in nondialysis chronic kidney disease (CKD) patients.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
authors: Michael
authors: M
authors: Mao
authors: Sarah
authors: S
authors: Lee
authors: Kianoush
authors: K
authors: Kashani
authors: Robert
authors: R
authors: Albright
authors: Qi
authors: Q
authors: Qian
mesh_terms: D000141:Acidosis, Renal Tubular / Q000139:chemically induced* / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002115:Calciphylaxis / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D006738:Hospices; D006801:Humans; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D007866:Leg; D006435:Renal Dialysis; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013885:Thiosulfates / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D016312:Treatment Refusal
chemical_list: D000975:Antioxidants; D013885:Thiosulfates; C017717:sodium thiosulfate
references: J Clin Pharmacol. 1992 Apr;32(4):368-75
references: 1569239
references: Clin J Am Soc Nephrol. 2011 May;6(5):1155-9
references: 21441129
references: Semin Dial. 2011 Jan-Feb;24(1):85-8
references: 21338397
references: Am J Kidney Dis. 2011 Dec;58(6):988-91
references: 21872378
references: Semin Dial. 2005 Sep-Oct;18(5):431-4
references: 16191185
references: Clin J Am Soc Nephrol. 2008 Jul;3(4):1139-43
references: 18417747
references: J Am Acad Dermatol. 2007 Apr;56(4):569-79
references: 17141359
references: Lancet. 2008 Sep 13;372(9642):892
references: 18790311
references: Cardiovasc Diabetol. 2005 Mar 18;4:4
references: 15777477