Ferric carboxymaltose
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Hypophosphataemia: case report A 40-year-old woman developed hypophosphataemia during treatment with ferric carboxymaltose for iron deficiency anaemia. The woman attended an outpatient clinic to receive IV ferric carboxymaltose [Ferinject] infusion 1000mg on 12 November 2019. One year prior, she had received the similar unspecified treatment for ongoing low Hb secondary to poor absorption of oral iron supplementation in coeliac disease. After about 2 months post ferric carboxymaltose infusion, she experienced improvement only in fatigue. After the second infusion of ferric carboxymaltose [dose not stated], on day 0, she did not notice any improvement in symptoms of iron deficiency anaemia, the symptoms of which included fatigue, dyspnoea and dizziness. On day 6, blood test showed hypophosphataemia, which was attributed to ferric carboxymaltose therapy. The woman was administered phosphate infusion according to local Trust protocol for hypophosphataemia. However, her serum phosphate level did not normalise, and her symptoms deteriorated. She was therefore presented to the emergency department of the hospital on day 8. She received another infusion of phosphate, the dosage of which had to be reduced due to hypocalcaemia [aetiology not stated] requiring calcium administration. Additional four phosphate infusions were administered, and vitamin-D supplementation was started. In view of extremely low phosphate levels, inhibitory effect on Fibroblast Growth Factor-23 levels, and her anxiety, propranolol was administered. Her main symptoms were severe bone pain, sensation of pressure on chest and extreme fatigue. On day 15, phosphate and propranolol were discontinued. By day 42, her urinary phosphate excretion and serum phosphate levels normalised. High phosphate diet and vitamin-D supplementation were provided for a total of 8 weeks. By day 50, the bone and chest pain (extending from sternum to back and limbs, with crushing headache) reduced. Her subsequent course showed sickness absence for 8 weeks, although the fatigue persisted beyond day 56. Fisher S, et al. Ferric carboxymaltose (Ferinject) associated hypophosphataemia: case report illustrating the need for increased awareness to minimise incidence and risk. 803517456 Acute Medicine 19: 102-105, No. 2, Jan 2020. Available from: URL: https://pubmed.ncbi.nlm.nih.gov/32840261/
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Reactions 28 Nov 2020 No. 1832
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