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Hypophosphataemia: case report A 70-year-old man developed hypophosphataemia during treatment with ferric carboxymaltose for iron-deficiency anaemia. The man, who had chronic recurrent gastrointestinal bleeding from gastric antral vascular ectasia (GAVE), presented to the emergency department with worsening lethargy and dizziness. It was reported that 2 weeks prior to the current presentation he had received parenteral ferric carboxymaltose [dosages not stated] for iron-deficiency anaemia. He had no evidence of gastrointestinal bleeding, breathlessness, chest discomfort, focal weakness, vomiting and diarrhoea. A 12-lead ECG and clinical examination were found to be unremarkable. Neurological examinations showed no focal neurological findings. His serum phosphate level was found to be below 0.32 mmol/L. Therefore, the man was admitted and initiated on IV phosphate replacement therapy. His renal function, magnesium, calcium and creatinine kinase levels were within normal limits. Of note, there was no clinically apparent causes of hypophosphataemia. However, his haemoglobin level remained low, and he was again administered with another dose of ferric carboxymaltose. Regardless of IV and oral phosphate replacement, he remained hypophosphataemic with persistent lethargy and dizziness. The low ratio of tubular maximum reabsorption of phosphate (TmP) to glomerular filtration rate (GFR) suggested renal phosphate wasting. His 25-hydroxyvitamin D level was normal with elevated serum fibroblast-growth-factor 23. He was started on calcitriol, colecalciferol, and fleet phospho-soda containing phosphate. Eventually, his serum phosphate levels normalised. His oral phosphate replacement was stopped after 11 weeks. In view of severe hypophosphataemia due to ferric carboxymaltose [duration of treatment to reaction onset not stated], parenteral ferric carboxymaltose was stopped, and he was started on high-dose oral iron replacement therapy. Thereafter, his serum phosphate levels remained normal without further replacement. It was reported that he had received a total of 26 doses of parenteral ferric carboxymaltose in the previous 3 years and was admitted for non-specific symptoms like lethargy, palpitations and chest discomfort, which were common symptoms of anaemia and hypophosphataemia. Therefore, hypophosphataemia remained undiagnosed for a long time. Teh KK-J, et al. Severe symptomatic hypophosphataemia as a complication of parenteral iron replacement. European Journal of Case Reports in Internal Medicine 7: No. 11, 803519407 20 Aug 2020. Available from: URL: http://doi.org/10.12890/2020_001860

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Reactions 5 Dec 2020 No. 1833