Sodium Thiosulfate as a Treatment for Persistent Metabolic Alkalosis Induced by Diuretics: A Case Series Involving Six Patients September 1, 2026 Annals Of Internal Medicine: Clinical Cases Share Summary Takeaways Insight Report Clinical Scorecard Quiz Poll 1 Sodium thiosulfate (STS) was used in six patients with diuretic-induced metabolic alkalosis after standard treatments failed. 2 All patients had persistent hypervolemia and required ongoing diuresis despite receiving loop and thiazide diuretics. 3 STS administration resulted in a decrease in serum total carbon dioxide levels, averaging approximately 5 mmol/L per 25 g dose. 4 No immediate adverse effects from STS were observed in any of the six patients during the treatment. 5 The study highlights the limitations of standard treatments for metabolic alkalosis in patients with impaired renal function.