Clinical Scorecard: Sodium Thiosulfate as a Treatment for Persistent Metabolic Alkalosis Induced by Diuretics: A Case Series Involving Six Patients

At a Glance

Key Highlights

• Sodium thiosulfate (STS) was effective in treating refractory metabolic alkalosis.
• All patients had impaired renal function at the time of STS therapy initiation.
• Standard therapies failed to correct alkalosis in these patients.
• No immediate adverse effects were observed following STS administration.
• Average decrease in serum total carbon dioxide was approximately 5 mmol/L per 25 g of STS.

Guideline-Based Recommendations

Diagnosis

• Metabolic alkalosis should be diagnosed in patients receiving loop and thiazide diuretics.

Management

• Standard treatments include acetazolamide and potassium-sparing diuretics.

Monitoring & Follow-up

• Monitor serum potassium levels to maintain above 3.5 mmol/L.

Risks

• Untreated metabolic alkalosis may lead to complications such as hypokalemia, hypophosphatemia, and cardiac arrhythmias.

Patient & Prescribing Data

Six patients with diuretic-induced metabolic alkalosis and fluid overload.

Sodium thiosulfate should be reserved for refractory cases despite optimal diuretic therapy.

Clinical Best Practices

• Consider sodium thiosulfate for patients with persistent metabolic alkalosis unresponsive to standard therapies.
• Evaluate renal function before initiating STS therapy.

Related Resources & Content

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