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Refractory hypophosphatemia following ferric carboxymaltose administration

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Abstract

Hypophosphatemia is a rare side effect of intravenous iron replacement. Urinary phosphate wasting due to increased FGF23 is the most likely mechanism. Here, we present a case of intractable hypophosphatemia in a 32-year-old female patient with history of ulcerative colitis (UC), who was primarily hospitalized due to UC flare-up. Her urinary fractional excretion of phosphate was inappropriately elevated at 70%. A careful history revealed that she had been treated with ferric carboxymaltose 2 weeks prior to hospitalization, leading to a diagnosis of iron-induced hypophosphatemia. She was treated with 5 weeks of intravenous sodium phosphate since she did not tolerate oral supplementation. In conclusion, clinicians should be aware of iron-induced hypophosphatemia and be cautious when prescribing intravenous iron.

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Acknowledgements

All authors had access to the data and role in writing the manuscript. Informed consent was obtained from all individual participants included in the study.

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Author notes

  1. Orhan Efe and Juan David Cala García equally contributed to the case report.

Authors and Affiliations

  1. Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Orhan Efe, David Bruce Mount & Alice Marie Sheridan

  2. Visiting Medical Student, Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Juan David Cala García

  3. Nephrology Fellow, PGY-5, Combined Nephrology Program, Brigham Women’s Hospital/Mass General Hospital, 45 Francis Street, MRB-4, Boston, MA, 02115, USA

    Orhan Efe

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  1. Orhan Efe
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  2. Juan David Cala García
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  3. David Bruce Mount
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  4. Alice Marie Sheridan
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Correspondence to Orhan Efe.

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Efe, O., García, J.D.C., Mount, D.B. et al. Refractory hypophosphatemia following ferric carboxymaltose administration. CEN Case Rep 10, 473–475 (2021). https://doi.org/10.1007/s13730-021-00590-1

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  • DOI: https://doi.org/10.1007/s13730-021-00590-1

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