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Unexpectedly Severe Metabolic Acidosis Associated with Sodium Thiosulfate Therapy in a Patient with Calcific Uremic Arteriolopathy
Author(s) -
Selk Natalie,
Rodby Roger A.
Publication year - 2011
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2011.00848.x
Subject(s) - calciphylaxis , medicine , sodium thiosulfate , metabolic acidosis , sepsis , uremia , acidosis , pathophysiology , intensive care medicine , kidney disease , disease , surgery , inorganic chemistry , chemistry
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.