Hypophosphatemia induced encephalopathy after intravenous iron carboxymaltase administration – A rare and important complication

@#Recently, intravenous iron supplements has become increasingly popular because it allows administration of large quantity of iron dosage with simple infusion and is more effective in raising the hemoglobin levels and have less drug-related side effects as compared to oral iron supplementation. Multiple IV formulations of iron are available. However, there have been reports of transient asymptomatic hypophosphatemia with its use. We report here a patient with iron deficiency anemia secondary to menorrhagia, who presented with confusion, disorientation, muscle cramps and severe fatigue 3 weeks following intravenous ferric carboxymaltase from hypophosphatemia.

Hyperammonemic coma presenting as Hashimoto's encephalopathy.

Hyperammonemia is commonly encountered in active liver disease. Evaluation of patients having hyperammonemia with normal liver function is difficult. We present a case referred to us as undiagnosed hyperammonemic coma with normal liver function, who was subsequently diagnosed to have Hashimoto's encephalopathy. In patients with hyperammonemia without hepatic dysfunction, one must search for the presence of hypothyroidism. Hashimoto's encephalopathy though described to be rare in literature, is often underlooked. In patients with undiagnosed coma, one must look for it as it is easy to diagnose and treat.