Keywords
Hypophosphataemia
Anaemia
How to Cite
Abstract
Background
Due to the gastrointestinal side-effects of oral iron supplementation in patients with iron deficiency anaemia, which impairs tolerance - many acute medical and haematology day units provide intravenous iron replacement therapy as day cases. Hypophosphatemia is a frequent side effect following intravenous iron administration, which can persist for weeks or months, is under-recognised in clinical practice and can lead to patients presenting with typical features to the emergency departments.
Aim
We designed an audit to measure the incidence of symptomatic hypophosphatemia after intravenous iron therapy to develop monitoring, prevention, and treatment strategy in a secondary care hospital setting.
Methods
We audited a convenience sample of consecutive patients who attended an acute day-care assessment unit for intravenous (IV) iron infusion (ferric carboxymaltose). All patients had serum phosphate levels checked after IV iron infusion at different intervals, from 1- 6 weeks. The cohort was divided into two groups based on the occurrence of hypophosphataemia - early (1-3 weeks) and late (>3-6 weeks).
Results
We included 35 patients referred from primary care, gastroenterology, gynaecology, and acute internal medicine. 19 (55%) developed hypophosphatemia after receiving a single IV iron infusion and almost 100% after more than one dose. Hypophosphatemia in some patients lasted up to 12 weeks.
Conclusion
Hypophosphatemia was frequent after a single dose and almost universal after multiple doses of IV Iron, which can persist for many weeks. Clinicians prescribing ferric carboxymaltose (Ferinject®) should be aware of hypophosphataemia, which could be mild, moderate, or severe and can last for months.
References
Ifie E, Oyibo SO, Joshi H, et al. Symptomatic hypophosphataemia after intravenous iron therapy: an underrated adverse reaction. Endocrinol Diabetes Metab Case Rep 2019;2019:19–0065. doi:10.1530/EDM-19-0065
Hardy S, Vandemergel X. Intravenous iron administration and hypophosphatemia in clinical practice. Int J Rheumatol 2015;2015:468675. doi:10.1155/2015/468675
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;28:1793–803. doi:10.1002/jbmr.1923
Shimada T, Mizutani S, Muto T, et al. Cloning and characterization of FGF23 as a causative factor of tumor-induced osteomalacia. Proc Natl Acad Sci U S A 2001;98:6500–5. doi:10.1073/pnas.101545198
Liu P-Y, Jeng C-Y. Severe hypophosphatemia in a patient with diabetic ketoacidosis and acute respiratory failure. J Chin Med Assoc 2004;67:355–9.
de Oliveira Iglesias SB, Pons Leite H, de Carvalho WB. Hypophosphatemia-induced seizure in a child with diabetic ketoacidosis. Pediatr Emerg Care 2009;25:859–61. doi:10.1097/PEC.0b013e3181c399f6
Turnbull J, Lumsden D, Siddiqui A, et al. Osmotic demyelination syndrome associated with hypophosphataemia: 2 cases and a review of literature. Acta Paediatrica 2013;102:e164–8. doi:10.1111/apa.12143
O’Connor LR, Wheeler WS, Bethune JE. Effect of hypophosphatemia on myocardial performance in man. N Engl J Med 1977;297:901–3. doi:10.1056/NEJM197710272971702
Ognibene A, Ciniglio R, Greifenstein A, et al. Ventricular tachycardia in acute myocardial infarction: the role of hypophosphatemia. South Med J 1994;87:65–9. doi:10.1097/00007611-199401000-00014
Osteomalacic myopathy - Russell - 1994 - Muscle & Nerve - Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1002/mus.880170603 (accessed 3 Jun 2023).
Singhal PC, Kumar A, Desroches L, et al. Prevalence and predictors of rhabdomyolysis in patients with hypophosphatemia. Am J Med 1992;92:458–64. doi:10.1016/0002-9343(92)90740-3
Poesen R, Dierickx D, Evenepoel P. Hemolytic anemia associated with severe hypophosphatemia in a renal transplant recipient. Transpl Int 2012;25:e27-28. doi:10.1111/j.1432-2277.2011.01393.x
Yamashita C, Shigeto H, Maeda N, et al. A Case of Central Pontine Myelinolysis Caused by Hypophosphatemia Secondary to Refeeding Syndrome. Case Rep Neurol 2015;7:196–203. doi:10.1159/000440711
Glaspy JA, Lim-Watson MZ, Libre MA, et al. Hypophosphatemia Associated with Intravenous Iron Therapies for Iron Deficiency Anemia: A Systematic Literature Review. Ther Clin Risk Manag 2020;16:245–59. doi:10.2147/TCRM.S243462
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Array