# Intravenous Iron (III) Hydroxide Polymaltose Complex Infusion Related Severe Prolonged Hypophosphatemia

## TL;DR

A 60-year-old woman developed severe low phosphate levels after receiving iron infusions, which were successfully treated with phosphate supplements.

## Contribution

This is the first reported case of severe hypophosphatemia following iron (III) hydroxide polymaltose complex infusion.

## Key findings

- Severe hypophosphatemia (<0.1 mmol/dL) occurred after three IPC infusions in a patient with multiple comorbidities.
- The patient was asymptomatic and responded well to intravenous and oral phosphate treatment.
- The case highlights the need for awareness of hypophosphatemia as a potential complication of IPC infusions.

## Abstract

Intravenous iron infusion-related hypophosphatemia is an increasingly recognized phenomenon, potentially underdiagnosed in clinical practice. This case report describes the first known instance to the best of our knowledge, of severe hypophosphatemia following iron (III) hydroxide polymaltose complex (IPC) infusion in a 60-year-old woman with multiple comorbidities. The patient, with a history of diabetes mellitus type 2, hyperlipidemia, stable stage 3 chronic kidney disease, iron deficiency anemia, and osteoporosis, was found to have severe asymptomatic hypophosphatemia (<0.1 mmol/dL) during a general workup. She exhibited mild chronic numbness of the hands and feet, restless leg syndrome, and muscular pain in her shoulders, though her clinical examination was unremarkable. The patient had received three IPC infusions over two months prior to presentation. She was admitted and treated with intravenous phosphate followed by oral sodium phosphate. The patient remained well and asymptomatic throughout the treatment.