Sodium Thiosulfate and Acidosis: A Puzzle for Readers
Hello. This is Jeffrey Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. I am Editor-in-Chief of Medscape Nephrology. Today, instead of waxing eloquent on some topic, I am going to pose a question to the readers and hope that we can get an answer to a clinical problem that has been tossed around between myself and some of my colleagues over the last week or so.
The question has to do with sodium thiosulfate. It has been used to treat calciphylaxis in patients on hemodialysis. One of the known consequences of sodium thiosulfate administration is an elevation in the anion gap, which is explained by the dissociation of the molecule into thiosulfuric acid. Not explained is the development of acidosis in most patients (or at least many patients) who get sodium thiosulfate. In some reports, the acidosis was associated with a pronounced increase in the anion gap.
A variety of explanations have been tossed out in the literature as to why patients who receive sodium thiosulfate develop metabolic acidosis, but none of them seem satisfactory. The biggest problem is that sodium thiosulfate lacks protons, so it can't contribute a proton for the development of acidosis. The solution in which sodium thiosulfate is administered can have an acid pH, but when one does the math, there are not enough protons in that solution to account for a significant metabolic acidosis. Thiosulfate may have an effect on other biological systems throughout the body that must lead to generation of metabolic acidosis. But so far, we have not been able to come up with a good explanation.
So, I am tossing this out there to all the brilliant nephrologists who read Medscape Nephrology to see if anybody can help us out. Send me an email or submit your reply via the Medscape Nephrology site. We are eager to find out the correct explanation as to why patients who get sodium thiosulfate develop metabolic acidosis. So far, it has proven to be a real puzzler.
I look forward to hearing from you. Hopefully we'll be able to solve this problem. This is Jeffrey Berns from Philadelphia, Editor-in-Chief of Medscape Nephrology.
Hello. This is Jeffrey Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. I am Editor-in-Chief of Medscape Nephrology. Today, instead of waxing eloquent on some topic, I am going to pose a question to the readers and hope that we can get an answer to a clinical problem that has been tossed around between myself and some of my colleagues over the last week or so.
The question has to do with sodium thiosulfate. It has been used to treat calciphylaxis in patients on hemodialysis. One of the known consequences of sodium thiosulfate administration is an elevation in the anion gap, which is explained by the dissociation of the molecule into thiosulfuric acid. Not explained is the development of acidosis in most patients (or at least many patients) who get sodium thiosulfate. In some reports, the acidosis was associated with a pronounced increase in the anion gap.
A variety of explanations have been tossed out in the literature as to why patients who receive sodium thiosulfate develop metabolic acidosis, but none of them seem satisfactory. The biggest problem is that sodium thiosulfate lacks protons, so it can't contribute a proton for the development of acidosis. The solution in which sodium thiosulfate is administered can have an acid pH, but when one does the math, there are not enough protons in that solution to account for a significant metabolic acidosis. Thiosulfate may have an effect on other biological systems throughout the body that must lead to generation of metabolic acidosis. But so far, we have not been able to come up with a good explanation.
So, I am tossing this out there to all the brilliant nephrologists who read Medscape Nephrology to see if anybody can help us out. Send me an email or submit your reply via the Medscape Nephrology site. We are eager to find out the correct explanation as to why patients who get sodium thiosulfate develop metabolic acidosis. So far, it has proven to be a real puzzler.
I look forward to hearing from you. Hopefully we'll be able to solve this problem. This is Jeffrey Berns from Philadelphia, Editor-in-Chief of Medscape Nephrology.