From the Research
The correct answer is A. Sodium mafenide, as it is a topical antimicrobial agent used for burn wound treatment that can cause metabolic acidosis as a complication. This occurs because mafenide acetate is a carbonic anhydrase inhibitor, which interferes with the kidney's ability to excrete acid. When applied to large burn surfaces, sufficient amounts can be absorbed systemically to inhibit carbonic anhydrase in the renal tubules, leading to decreased bicarbonate reabsorption and subsequent metabolic acidosis 1.
Neither silver nitrate nor silver sulfadiazine inhibits carbonic anhydrase to a significant degree, so they do not typically cause metabolic acidosis. The most recent and highest quality study, published in 2022, categorizes metabolic acidoses by mechanism and by the presence or absence of an increased anion gap, but does not mention silver nitrate or silver sulfadiazine as common causes of metabolic acidosis 1.
Key points to consider when using sodium mafenide for burn treatment include:
- Monitoring the patient's acid-base status, especially when treating extensive burns
- Being prepared to provide appropriate intervention if metabolic acidosis develops
- Understanding the pathophysiology of metabolic acidosis, including the role of carbonic anhydrase inhibitors like mafenide acetate
- Recognizing the importance of identifying the primary causative etiology of metabolic acidosis, as discussed in the 2022 review of clinical disorders causing metabolic acidosis 1.
In clinical practice, it is essential to prioritize the patient's morbidity, mortality, and quality of life when managing metabolic acidosis, and to be aware of the potential complications of topical antimicrobial agents like sodium mafenide.