Severe Anion Gap Acidosis Associated with Intravenous Sodium Thiosulfate Administration

Michael Mao, Sarah Lee, Kianoush Kashani, Robert Albright, Qi Qian

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Introduction: Severe anion gap (AG) acidosis associated with intravenous sodium thiosulfate (STS) administration has not been previously described in nondialysis chronic kidney disease (CKD) patients. Case Report: We present a CKD patient with a baseline creatinine 1.8 mg/dL (eGFR 28 ml/min/1.73 m2) who developed sustained and life-threatening AG acidosis associated with intravenous STS treatment for calciphylaxis. Discussion: Although marketed as a safe drug, STS can cause life-threatening acidosis as illustrated in this case. STS-induced AG acidosis should be considered in the differential diagnosis of severe acidosis in patients receiving STS. Dosage adjustment and close follow-up of patients' acid-base status after STS initiation is necessary.

Original languageEnglish (US)
Pages (from-to)274-277
Number of pages4
JournalJournal of Medical Toxicology
Issue number3
StatePublished - Sep 2013


  • Anion gap acidosis
  • Calciphylaxis
  • Chronic kidney disease
  • Sodium thiosulfate (STS)

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis


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