Recurrent Hypophosphatemia Following a Single Dose of Parenteral Iron Administration

Although parenteral iron is widely used to treat iron deficiency anemia (IDA), some side effects have been inadequately explored. Hypophosphatemia is becoming a well-documented, yet poorly understood, side effect of parenteral iron infusion, oftentimes causing serious and/or prolonged complications. In this article, we discuss the case of a 33-year-old female with IDA who suffered debilitating physical and mental symptoms of significant recurrent hypophosphatemia following a single standard dose of parenteral iron administration. Despite initial management with repeated parenteral and oral phosphate replacement, the hypophosphatemia, along with its symptoms and sequelae, persisted until active vitamin D supplementation with calcitriol was commenced following a multispecialty team decision. This case highlights the deficiencies in the recognition and management of parenteral iron-induced hypophosphatemia and proposes a requirement for standardization in its management strategies, including the use of vitamin D supplementation.