Severe Symptomatic Hypophosphataemia as a Complication of Parenteral Iron Replacement

  • Kevin Kim-Jun Teh Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  • Matthew Bingfeng Chuah Department of Endocrinology, Sengkang General Hospital, Singapore
  • Shu-Wen Tay Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  • Amanda Yuan-Ling Lim Department of Medicine, National University Health System, Singapore
  • Joan Joo-Ching Koo Department of Endocrinology, Changi General Hospital, Singapore

Keywords

Hypophosphataemia, parenteral iron replacement, FGF23-mediated renal phosphate wasting

Abstract

Parental iron replacement is given to patients with severe iron deficiency or intolerance to oral iron. Hypophosphataemia has been reported to occur as a complication of parental iron replacement, and is postulated to be related to the carbohydrate moieties used in the parenteral preparations. Hypophosphataemia is under-diagnosed as symptoms such as fatigue, muscle weakness and poor effort tolerance mimic anaemia. Severe hypophosphataemia (<0.32 mmol/l) can result in significant complications such as confusion, rhabdomyolysis and arrhythmias. We report a patient with recurrent admissions for non-specific symptoms attributed to iron deficiency anaemia who received multiple doses of parenteral ferric carboxymaltose (FCM). He was found to have severe hypophosphataemia, with further evaluation showing increased renal phosphate wasting and elevated serum levels of fibroblast-growth-factor 23 (FGF23). FCM was stopped and he was given high-dose oral iron supplementation, with no further episodes of hypophosphataemia.

VIEW THE ENTIRE ARTICLE

References

Walton RJ, Bijvoet OL. Nomogram for derivation of renal threshold phosphate concentration. Lancet 1975;2(7929):309–310.

Jüppner H, Wolf M, Salusky IB. FGF-23: more than a regulator of renal phosphate handling? J Bone Miner Res 2010;25(10):2091–2097.

Hardy S, Vandemergel X. Intravenous iron administration and hypophosphatemia in clinical practice. Int J Rheumatol 2015;2015:468675.

Schouten BJ, Hunt PJ, Livesey JH, Frampton CM, Soule SG. FGF23 elevation and hypophosphatemia after intravenous iron polymaltose: a prospective study. J Clin Endocrinol Metab 2009;94(7):2332–2337.

Wolf M, Koch TA, Bregman DB. Effects of iron deficiency anemia and its treatment on fibroblast growth factor 23 and phosphate homeostasis in women. J Bone Miner Res 2013;28(8):1793–1803.

Published: 2020-08-20

Issue: Vol 7 No 11 (view)

Section: Articles

How to cite:
1.
Teh KK-J, Chuah MB, Tay S-W, Lim AY-L, Koo JJ-C. Severe Symptomatic Hypophosphataemia as a Complication of Parenteral Iron Replacement . EJCRIM 2020;7 doi:10.12890/2020_001860.

Most read articles by the same author(s)