Clinical Report: Sodium Thiosulfate for Diuretic-Induced Metabolic Alkalosis

Overview

This case series reports the use of sodium thiosulfate (STS) in six patients with persistent metabolic alkalosis induced by diuretics. The intervention was effective in reducing serum bicarbonate levels without immediate adverse effects.

Background

Metabolic alkalosis is a common complication of loop and thiazide diuretics, which can hinder effective decongestion in patients with fluid overload. Standard treatments often fail, necessitating alternative strategies to manage alkalosis while maintaining diuretic therapy. Sodium thiosulfate was explored as a potential treatment in this context.

Data Highlights

Key Findings

• All six patients had refractory metabolic alkalosis despite standard treatments.
• Sodium thiosulfate was administered to induce metabolic acidosis.
• Serum total carbon dioxide levels declined in all patients following STS administration.
• Patients remained on continuous loop diuretics during STS treatment.
• Four patients had preexisting chronic kidney disease.
• None of the patients experienced immediate adverse effects from STS.

Clinical Implications

Clinicians should monitor for potential sodium load effects when using sodium thiosulfate in cases of refractory alkalosis.

Conclusion

The use of sodium thiosulfate in this case series demonstrates its application in treating persistent metabolic alkalosis in patients requiring ongoing diuretic therapy.

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