Sodium Thiosulfate for Refractory Metabolic Alkalosis From Diuretic Therapy: A Case Series of Six Patients

Loop and thiazide diuretics can cause metabolic alkalosis. Standard treatments for management of alkalosis in patients requiring continued decongestion are not always successful. Sodium thiosulfate (STS) is known to cause metabolic acidosis. We describe the use of STS for diuretic-induced metabolic alkalosis in 6 patients with unresolved hypervolemia requiring continued decongestion in whom standard treatments (acetazolamide, potassium-sparing diuretics) failed. This intervention was effective and without immediate adverse effects, offering a novel strategy for this clinical problem. Given the large sodium load, STS should be reserved for refractory alkalosis in patients on optimal diuretic therapy with an adequate natriuretic response.