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Small bowel and Nutrition
Short report
Severe hypophosphataemia following ferric carboxymaltose infusion in paediatric patients with inflammatory bowel disease
  1. Rachel Elizabeth Harris1,
  2. Lawrence Armstrong2,
  3. Lee Curtis1,
  4. Vikki Garrick1,
  5. Lisa Gervais1,
  6. Rachel Tayler1,
  7. Richard Hansen1,
  8. Richard K Russell1
  1. 1 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children Glasgow, Glasgow, UK
  2. 2 Department of Paediatrics, University Hospital Crosshouse, Kilmarnock, UK
  1. Correspondence to Dr Rachel Elizabeth Harris,Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children Glasgow, Glasgow, UK; rachel.harris16{at}nhs.net

Abstract

This case series describes the cases of three adolescent patients with established inflammatory bowel disease (IBD) who experienced significant hypophosphataemia following intravenous infusion of ferric carboxymaltose as treatment for iron deficiency anaemia. Hypophosphataemia may cause a diverse range of symptoms and may be difficult to diagnose clinically due to their non-specific nature. Checking a baseline phosphate (PO4) prior to intravenous iron infusion may identify patients at higher risk for significant hypophosphataemia and perhaps allow the selection of an alternative iron preparation. The routine monitoring of PO4 levels postinfusion presents a greater challenge; with cases of asymptomatic hypophosphataemia likely to be uncovered, as in case 3. Clinicians, patients and families should be aware of the symptoms of hypophosphataemia, and symptomatic patients should have bloods checked to allow prompt identification and correction of abnormalities where required. Review of guidelines surrounding intravenous iron infusion and management of hypophosphataemia in paediatric patients is now required.

  • paediatric gastroenterology
  • inflammatory bowel disease

https://doi.org/10.1136/flgastro-2019-101242

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    Footnotes

    • Contributors REH prepared the manuscript with comments and review from all authors. LA, LC, VG, LG, RT, RH and RKR provided critical review of the manuscript. All authors have approved the uploaded draft.

    • Funding The IBD team at the Royal Hospital for Children, Glasgow are supported by the Catherine McEwan Foundation.

    • Competing interests LC has received conference, accommodation and travel fees from Ferring and conference fees from Tillots. VG has received speaker’s fees from Ferring and conference fees from Abbvie. LG has participated in a research consultancy session with Lilly. RH is supported by an NHS Research Scotland Senior Research Fellowship, and has received speaker’s fees, travel support and/or participated in medical board meetings with MSD Immunology, Dr Falk, Nutricia & 4D Pharma. RKR is supported by an NHS Research Scotland Senior Research Fellowship and has received speaker’s fees, travel support and/or participated in medical board meetings with Nestle, MSD Immunology, AbbVie, Dr Falk, Takeda, Napp, Mead Johnson, Nutricia & 4D Pharma.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.