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1.
Eur J Pediatr ; 183(4): 1935-1941, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38347260

RESUMEN

This study aims to investigate the potential correlation between the use of olanzapine, a psychopharmacological intervention commonly prescribed in Anorexia Nervosa treatment, and the occurrence of Refeeding Syndrome. Despite the acknowledged nutritional and biochemical impacts of olanzapine, the literature lacks information regarding its specific association with Refeeding Syndrome onset in individuals with Anorexia Nervosa. This is a naturalistic, retrospective, observational study, reporting the occurrence of Refeeding Syndrome in children and adolescents with Anorexia Nervosa, treated or untreated with olanzapine. Dosages and serum levels of olanzapine were assessed for potential associations with the occurrence of Refeeding Syndrome and specific variations in Refeeding Syndrome-related electrolytes. Overall, 113 patients were enrolled, including 46 (41%) who developed a Refeeding Syndrome. Mild (87%), moderate (6.5%), and severe (6.5%) Refeeding Syndrome was described, at a current average intake of 1378 ± 289 kcal/day (39 ± 7.7 kcal/kg/die), frequently associated with nasogastric tube (39%) or parenteral (2.2%) nutrition. Individuals receiving olanzapine experienced a more positive phosphorus balance than those who did not (F(1,110) = 4.835, p = 0.030), but no difference in the occurrence of Refeeding Syndrome was documented. The mean prescribed doses and serum concentrations of olanzapine were comparable between Refeeding Syndrome and no-Refeeding Syndrome patients.    Conclusion: The present paper describes the occurrence of Refeeding Syndrome and its association with olanzapine prescriptions in children and adolescents with Anorexia Nervosa. Olanzapine was associated with a more positive phosphorus balance, but not with a different occurrence of Refeeding Syndrome. Further, longitudinal studies are required. What is Known: • Refeeding Syndrome (RS) is a critical complication during refeeding in malnourished patients, marked by electrolyte (phosphorus, magnesium, potassium) imbalances. • Olanzapine, an atypical antipsychotic with nutritional and biochemical impacts, is used in Anorexia Nervosa (AN) treatment, however data concerning its association with RS are lacking. What is New: • The study observed RS in 46/113 (41%) young patients with AN. • Olanzapine-treated individuals showed a higher improvement in serum phosphate levels than untreated ones, although no impact on the occurrence of Refeeding Syndrome was observed.


Asunto(s)
Anorexia Nerviosa , Hipofosfatemia , Síndrome de Realimentación , Niño , Humanos , Adolescente , Estudios Retrospectivos , Olanzapina/efectos adversos , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/tratamiento farmacológico , Síndrome de Realimentación/etiología , Hipofosfatemia/inducido químicamente , Fósforo , Equilibrio Hidroelectrolítico
2.
Bone ; 181: 117045, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38341165

RESUMEN

An 81-year-old Caucasian man who had commenced thrice weekly hemodialysis (HD) three months earlier, presented with a hip fracture, two vertebral fractures and a bone mineral density T-score of -3.6. He had received weekly iron sucrose infusions for 6 weeks and alphacalcidol on dialysis days. Although he suffered from coeliac disease and cirrhosis, he was fully ambulatory and well-nourished. He was normocalcaemic with a marginally low plasma phosphate and the PTH was 11.8 pmol/L (<2-times the upper range of the assay). In view of his severe osteoporosis, it was decided to treat him with denosumab (dmab). Laboratory assessment 2 weeks post dmab showed severe hypophosphatemia and hypocalcemia; phosphate 0.11 mmol/L and ionized calcium 0.83 mmol/L, and he was admitted for intravenous phosphate infusion. Three months later he remained on a phosphate supplement. The case illustrates that, in addition to the risks of hypocalcemia in patients with kidney failure and high bone turnover, kidney failure patients without evidence of high bone turnover, can also be at risk of hypocalcemia and severe hypophosphatemia requiring acute hospitalization and phosphate infusion. The potential role of compromised phosphate absorption versus increased deposition will be discussed. We recommend a cautious approach to dmab therapy in patients on dialysis, with evaluation of bone turnover and serum phosphate levels prior to initiation of treatment.


Asunto(s)
Conservadores de la Densidad Ósea , Hipocalcemia , Hipofosfatemia , Insuficiencia Renal , Humanos , Masculino , Anciano de 80 o más Años , Denosumab/efectos adversos , Hipocalcemia/inducido químicamente , Hipofosfatemia/inducido químicamente , Diálisis Renal/efectos adversos , Fosfatos , Insuficiencia Renal/inducido químicamente , Conservadores de la Densidad Ósea/efectos adversos , Densidad Ósea
3.
Clin Nephrol ; 101(2): 93-98, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38032142

RESUMEN

A sporadic occurrence of Fanconi syndrome associated with adefovir dipivoxil (ADV) has been reported, particularly when confirmed by renal biopsy. This study presents the case of a 53-year-old man who had been taking ADV 10 mg daily for 10 years to treat chronic hepatitis B (CHB) and subsequently developed Fanconi syndrome. The clinical manifestations included hypophosphatemic osteomalacia, glucosuria, renal tubular acidosis, low-molecular-weight proteinuria, and renal insufficiency. Renal biopsy revealed significant injury to proximal tubular epithelial cells, including vacuolar degeneration and regeneration of tubular epithelial cells. The ultrastructural pathology indicated severe morphological abnormalities of mitochondria, such as densely packed and enlarged mitochondria, with loss, blunting, and disordered arrangement of cristae. Following discontinuation of ADV and supplementation with oral phosphate, hypophosphatemia, glucosuria, and proteinuria were resolved. These findings support the previous hypothesis that ADV-induced nephrotoxicity may involve mitochondrial injury.


Asunto(s)
Adenina/análogos & derivados , Síndrome de Fanconi , Glucosuria , Hepatitis B Crónica , Hipofosfatemia , Organofosfonatos , Osteomalacia , Insuficiencia Renal , Masculino , Humanos , Persona de Mediana Edad , Síndrome de Fanconi/inducido químicamente , Síndrome de Fanconi/diagnóstico , Síndrome de Fanconi/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Riñón , Hipofosfatemia/inducido químicamente , Glucosuria/inducido químicamente , Proteinuria/tratamiento farmacológico , Osteomalacia/etiología , Antivirales/efectos adversos
4.
Br J Haematol ; 202(6): 1089-1090, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37528542

RESUMEN

Hypophosphataemia is a common side-effect in patients with iron deficiency anaemia treated with ferric carboxymaltose, which is not a class effect of all intravenous (IV) iron formulations. The report by Chu et al. shows that moderate and severe hypophosphataemia is common and can even require IV supplementation of phosphate with unknown long-term consequences. Commentary on: Chu et al. Incidence and predictors of hypophosphataemia after ferric carboxymaltose use-a 3-year experience from a single institution in Singapore. Br J Haematol 2023;202:1199-1204.


Asunto(s)
Anemia Ferropénica , Hipofosfatemia , Humanos , Compuestos Férricos/efectos adversos , Hierro , Maltosa/efectos adversos , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/etiología , Hipofosfatemia/etiología , Hipofosfatemia/inducido químicamente
5.
J Clin Endocrinol Metab ; 109(1): 293-302, 2023 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-37497620

RESUMEN

CONTEXT: Burosumab is approved for the treatment of X-linked hypophosphatemia (XLH). OBJECTIVE: To assess the efficacy and safety of burosumab in XLH patients, we conducted a systematic review and meta-analysis. METHODS: We searched PubMed, the Cochrane Library, Embase, ClinicalTrials.gov, and Web of Science for studies on the use of burosumab in patients with XLH. Meta-analysis of randomized controlled trials (RCTs) and single-arm trials (SATs) was done to explore burosumab treatment on the efficacy and safety of XLH. RESULTS: Of the 8 eligible articles, 5 were from RCTs and 3 were from SATs. Compared with the control group in RCTs, serum phosphorus level was significantly increased in the burosumab group (0.52 mg/dL, 95% CI 0.24-0.80 mg/dL). A meta-analysis of the burosumab arms in all trials revealed significant increase in serum phosphorus levels (0.78 mg/dL, 95% CI 0.61-0.96 mg/dL), TmP/GFR (0.86 mg/dL, 95% CI 0.60-1.12 mg/dL), and 1,25-dihydroxyvitamin D level (13.23 pg/mL, 95% CI 4.82-21.64 pg/mL) as well. Changes in secondary events also validated the effects of burosumab treatment. Compared with the control group, in RCTs, the safety profile of burosumab is not much different from the control group. Data of the single-arm combined group demonstrated the incidence of any treatment emergency adverse event (TEAE) and the related TEAE rate were high, but the severity of most adverse events is mild to moderate, and the rate of serious TEAE is low. CONCLUSION: This study suggests that burosumab can be an option for patients with XLH and did not significantly increase the incidence of adverse events.


Asunto(s)
Raquitismo Hipofosfatémico Familiar , Hipofosfatemia , Humanos , Anticuerpos Monoclonales/efectos adversos , Factores de Crecimiento de Fibroblastos , Fósforo , Hipofosfatemia/inducido químicamente
6.
Transfus Med ; 33(6): 503-508, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37263781

RESUMEN

OBJECTIVES: This case series would like to highlight hypophosphatemia related to ferric carboxymaltose and its adverse clinical consequences. BACKGROUND: Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia due to its ability to correct iron deficit with minimal infusions without incurring the gastrointestinal side effects of oral iron replacement. Ferric carboxymaltose is one common formula for intravenous iron supplementation. However, an increasingly recognised adverse side-effect of intravenous ferric carboxymaltose is hypophosphatemia. There has been increasing reports and studies highlighting hypophosphatemia related to intra-venous iron therapy. Though initially thought to be transient and asymptomatic, recent studies have shown that persistent hypophosphatemia in iron therapy can result in debilitating disease including myopathy, fractures and osteomalacia. METHODS: A retrospective analysis of all patients who had ferric carboxymaltose was performed. RESULTS: We highlight 3 cases where hyposphatemia affected the clinical outcomes. CONCLUSION: With the increased use of IV iron it is important to be aware of the high potential for hypophosphatemia secondary to ferric carboxymaltose.


Asunto(s)
Anemia Ferropénica , Hipofosfatemia , Humanos , Estudios Retrospectivos , Compuestos Férricos/efectos adversos , Hierro/uso terapéutico , Hipofosfatemia/inducido químicamente , Hipofosfatemia/tratamiento farmacológico , Hipofosfatemia/complicaciones , Anemia Ferropénica/tratamiento farmacológico , Administración Intravenosa
7.
Nephrol Dial Transplant ; 38(10): 2298-2309, 2023 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-37037771

RESUMEN

BACKGROUND: Hypophosphatemia is a common electrolyte disorder in critically ill patients undergoing prolonged kidney replacement therapy (KRT). We evaluated the efficacy and safety of a simplified regional citrate anticoagulation (RCA) protocol for continuous venovenous hemofiltration (CVVH), continuous venovenous hemodiafiltration (CVVHDF) and sustained low-efficiency dialysis filtration (SLED-f). We aimed at preventing KRT-related hypophosphatemia while optimizing acid-base equilibrium. METHODS: KRT was performed by the Prismax system (Baxter) and polyacrylonitrile AN69 filters (ST 150, 1.5 m2, Baxter), combining a 18 mmol/L pre-dilution citrate solution (Regiocit 18/0, Baxter) with a phosphate-containing solution (HPO42- 1.0 mmol/L, HCO3- 22.0 mmol/L; Biphozyl, Baxter). When needed, phosphate loss was replaced with sodium glycerophosphate pentahydrate (Glycophos™ 20 mmol/20 mL, Fresenius Kabi Norge AS, Halden, Norway). Serum citrate measurements were scheduled during each treatment. We analyzed data from three consecutive daily 8-h SLED-f sessions, as well as single 72-h CVVH or 72-h CVVHDF sessions. We used analysis of variance (ANOVA) for repeated measures to evaluate differences in variables means (i.e. serum phosphate, citrate). Because some patients received phosphate supplementation, we performed analysis of covariance (ANCOVA) for repeated measures modelling phosphate supplementation as a covariate. RESULTS: Forty-seven patients with acute kidney injury (AKI) or end stage kidney disease (ESKD) requiring KRT were included [11 CVVH, 11 CVVHDF and 25 SLED-f sessions; mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score 25 ± 7.0]. Interruptions for irreversible filter clotting were negligible. The overall incidence of hypophosphatemia (s-P levels <2.5 mg/dL) was 6.6%, and s-P levels were kept in the normality range irrespective of baseline values and the KRT modality. The acid-base balance was preserved, with no episode of citrate accumulation. CONCLUSIONS: Our data obtained with a new simplified RCA protocol suggest that it is effective and safe for CVVH, CVVHDF and SLED, allowing to prevent KRT-related hypophosphatemia and maintain the acid-base balance without citrate accumulation. TRIAL REGISTRATION: NCT03976440 (registered 6 June 2019).


Asunto(s)
Lesión Renal Aguda , Terapia de Reemplazo Renal Continuo , Hemofiltración , Hipofosfatemia , Humanos , Ácido Cítrico/efectos adversos , Terapia de Reemplazo Renal Continuo/efectos adversos , Equilibrio Ácido-Base , Anticoagulantes/efectos adversos , Hemofiltración/efectos adversos , Hemofiltración/métodos , Citratos/efectos adversos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/prevención & control , Terapia de Reemplazo Renal/efectos adversos , Fosfatos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/prevención & control
8.
Acta Clin Belg ; 78(4): 298-307, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36511107

RESUMEN

OBJECTIVES: Ferric carboxymaltose (FCM) is increasingly used in the management of cancer-related anemia, yet it may cause hypophosphatemia. This retrospective study describes the incidence, evolution and risk factors of hypophosphatemia in a cohort of patients with solid tumors receiving FCM. METHODS: Serum phosphorus concentration was assessed longitudinally using a random intercepts model. The probability of developing hypophosphatemia, as graded by CTCAE version 4.0, was investigated using a multi-state model. Transition hazards were modeled non-parametrically and semi-parametrically by a Cox model. Causal marginal risk differences between baseline interventions on serum phosphorus and/or FCM dose were obtained via G-computation. RESULTS: In 174 ambulatory patients with solid tumors receiving FCM at two university hospitals between October 2020 and September 2021, the risk of developing moderate-to-severe hypophosphatemia was 36.0% (95% confidence interval (CI) 28.2-43.9%) and peaked within 16 days after first FCM administration. The average duration of moderate-to-severe hypophosphatemia was 12.4 days. After adjustment for confounders, lower baseline serum phosphorus (adjusted hazard ratio (aHR) 0.88 per 0.1 mmol/L increase, 95% CI 0.79-0.98) and higher FCM dose (first dose: aHR 1.12 per 1 mg/kg increase, 95% CI 1.01-1.25; second dose: aHR 1.06 per 1 mg/kg increase, 95% CI 1.00-1.13) significantly increased the hazard of moderate-to-severe hypophosphatemia. CONCLUSION: Approximately one out of three ambulatory patients with solid tumors may develop moderate-to-severe hypophosphatemia after FCM administration. Baseline serum phosphorus and FCM dose may be modifiable risk factors that should be considered for intervention in order to mitigate the risk of hypophosphatemia.


Asunto(s)
Anemia Ferropénica , Hipofosfatemia , Neoplasias , Humanos , Estudios Retrospectivos , Incidencia , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/epidemiología , Compuestos Férricos/efectos adversos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/epidemiología , Hipofosfatemia/complicaciones , Factores de Riesgo , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/epidemiología , Fósforo
9.
Cancer Immunol Res ; 10(12): 1433-1440, 2022 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-36259217

RESUMEN

A major complication of chimeric antigen receptor (CAR) T-cell therapy is immune effector cell-associated neurotoxicity syndrome (ICANS), which presents as aphasia, confusion, weakness, somnolence, seizures, and coma. This is similar to the neurologic manifestations of hypophosphatemia, which can result from sudden increases in metabolic demand for phosphorylated intermediates (e.g., refeeding syndrome and sepsis). Given these similarities, we investigated whether CAR T-cell effector metabolic activity is associated with increased extracellular phosphate consumption and a possible association between hypophosphatemia and ICANS. In vitro 4-1BB and CD28 CD19-targeted CAR T-cell effector activity was found to be associated with increased consumption of media phosphorus, which was temporally associated with increased single-cell effector secretomic activity and increased phosphorus-dependent metabolic demand of the CAR T cells. A clinical cohort of 77 patients treated with CD19-targeted CAR T-cell therapy demonstrated a significant anticorrelation between serum phosphorus and ICANS incidence and severity, with earlier onset of hypophosphatemia after CAR T-cell infusion more likely to result in neurotoxicity. These results imply phosphorous level monitoring could alert to the development of ICANS in clinical scenarios. See related Spotlight by Tobin et al., p. 1422.


Asunto(s)
Hipofosfatemia , Síndromes de Neurotoxicidad , Humanos , Inmunoterapia Adoptiva/efectos adversos , Inmunoterapia Adoptiva/métodos , Receptores de Antígenos de Linfocitos T , Antígenos CD19 , Síndromes de Neurotoxicidad/etiología , Hipofosfatemia/inducido químicamente , Fósforo
10.
Zhonghua Yan Ke Za Zhi ; 58(9): 712-714, 2022 Sep 11.
Artículo en Chino | MEDLINE | ID: mdl-36069094

RESUMEN

A 52-year-old patient was initially diagnosed as hypophosphatemic osteomalacia in the Department of Endocrinology due to knee, foot and lumbosacral pain. The symptoms were not significantly relieved after phosphorus and vitamin D supplementation. Later, the imaging examination showed an orbital tumor in the right eye. The tumor was surgically removed, and the symptoms of systemic bone pain were relieved.


Asunto(s)
Hipofosfatemia , Neoplasias Orbitales , Osteomalacia , Humanos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/complicaciones , Persona de Mediana Edad , Neoplasias Orbitales/complicaciones , Osteomalacia/inducido químicamente , Osteomalacia/diagnóstico , Dolor/complicaciones , Síndromes Paraneoplásicos
11.
Drug Saf ; 45(10): 1019-1036, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36068430

RESUMEN

The intravenous iron formulations ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) offer the possibility of administering a large amount of iron in one infusion. This results in faster correction of anemia and the formulations being better tolerated than oral iron formulations. This triad of logistic advantages, improved patient convenience, and fast correction of anemia explains the fact that intravenous iron formulations nowadays are frequently prescribed worldwide in the treatment of iron deficiency anemia. However, these formulations may result in hypophosphatemia by inducing a strong increase in active fibroblast growth factor-23 (FGF-23), a hormone that stimulates renal phosphate excretion. This effect is much more pronounced with FCM than with FDI, and therefore the risk of developing hypophosphatemia is remarkably higher with FCM than with FDI. Repeated use of FCM may result in severe osteomalacia, which is characterized by bone pain, Looser zones (pseudofractures), and low-trauma fractures. Intravenous iron preparations are also associated with other adverse effects, of which hypersensitivity reactions are the most important and are usually the result of a non-allergic complement activation on nanoparticles of free labile iron-Complement Activation-Related Pseudo-Allergy (CARPA). The risk on these hypersensitivity reactions can be reduced by choosing a slow infusion rate. Severe hypersensitivity reactions were reported in < 1% of prospective trials and the incidence seems comparable between the two formulations. A practical guideline has been developed based on baseline serum phosphate concentrations and predisposing risk factors, derived from published cases and risk factor analyses from trials, in order to establish the safe use of these formulations.


Asunto(s)
Hipofosfatemia , Hierro , Disacáridos , Compuestos Férricos , Hormonas , Humanos , Hipofosfatemia/inducido químicamente , Maltosa/análogos & derivados , Fosfatos/efectos adversos , Estudios Prospectivos , Medición de Riesgo
12.
Int J Hematol ; 116(5): 647-658, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-35790696

RESUMEN

A multicenter, randomized, open-label, phase III study was conducted to compare the efficacy and safety of intravenous ferric derisomaltose (FDI) versus saccharated ferric oxide (SFO) in Japanese patients with iron deficiency anemia associated with menorrhagia. FDI can be administered as a single dose up to 1000 mg, whereas SFO has a maximum single dose of 120 mg. The primary endpoint, which was the maximum change in hemoglobin concentration from baseline, was noninferior for the FDI group compared with the SFO group. The incidence of treatment-emergent adverse events was lower in the FDI group (66.2%) than in the SFO group (90.8%). Notably, the incidence of serum phosphorus level < 2.0 mg/dL was significantly lower in the FDI group (8.4%) than in the SFO group (83.2%), and severe hypophosphatemia (≤ 1.0 mg/dL) occurred in 6.7% of SFO­treated patients compared with none in the FDI group. The percentage of patients who achieved the cumulative total iron dose during the 8-week treatment period was higher in the FDI group (92.8%) than in the SFO group (43.2%). The study met its primary endpoint, and also demonstrated the tolerability of a high dose of FDI per infusion, with a lower incidence of hypophosphatemia.


Asunto(s)
Anemia Ferropénica , Compuestos Férricos , Hipofosfatemia , Deficiencias de Hierro , Menorragia , Femenino , Humanos , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/etiología , Compuestos Férricos/uso terapéutico , Sacarato de Óxido Férrico/efectos adversos , Hemoglobinas/análisis , Hipofosfatemia/inducido químicamente , Hierro , Menorragia/complicaciones , Menorragia/tratamiento farmacológico , Fósforo/sangre
13.
Osteoporos Int ; 33(6): 1385-1395, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35088103

RESUMEN

The present study was the first prospective cohort evaluated the efficacy and safety of different doses of calcitriol in XLH children. The results suggested that a dose of 40 ng/kg/day calcitriol, compared with 20 ng/kg/day, was more effective in relieving the rickets, with similar safety outcomes. Further investigations were expected to set more dose groups. INTRODUCTION: Dose recommended for calcitriol in X-linked hypophosphatemia (XLH) varies in different studies. Therefore, we aimed to compare the efficacy as well as the safety of 20 ng/kg/d and 40 ng/kg/d calcitriol in Chinese XLH pediatrics population. METHODS: A 2-year, randomized, open-label, prospective study recruited 68 XLH children, which were randomized to receive either 40 ng/kg/day or 20 ng/kg/day calcitriol. Efficacy endpoints were the total Thacher ricket severity score (RSS) change from baseline to month 12 and 24, the difference in serum TALP level, fasting serum phosphate level, body height Z-score, and frequency of dental abscess. Safety assessments were done using renal ultrasound nephrocalcinosis grades (0-4), fasting serum and 24 h urine calcium level, and the occurrence of hyperparathyroidism. RESULTS: The decrease in the total RSS from baseline was more significant in the high-dose group at 12 (difference 0.87, p = 0.049) and 24 month (difference 1.23, p = 0.011). The serum TALP level was significantly lower in the high-dose group at 6 months. Pi level, height Z-score change, frequency of dental abscess and ratio of de novo nephrocalcinosis were comparable. A lower incidence of secondary hyperparathyroidism was seen in the high-dose group (p < 0.0001). CONCLUSION: For the first time in this prospective cohort, 40 ng/kg/d calcitriol was shown to be the more effective therapy in XLH children than the 20 ng/kg/d. Moreover, 40 ng/kg/d calcitriol was not associated with increasing adverse events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT 03,820,518.


Asunto(s)
Raquitismo Hipofosfatémico Familiar , Hipofosfatemia , Nefrocalcinosis , Absceso/tratamiento farmacológico , Calcitriol/efectos adversos , Niño , Raquitismo Hipofosfatémico Familiar/tratamiento farmacológico , Femenino , Humanos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/tratamiento farmacológico , Masculino , Nefrocalcinosis/tratamiento farmacológico , Fosfatos/efectos adversos , Estudios Prospectivos
14.
Therapie ; 76(6): 705-714, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33962799

RESUMEN

Iron deficiency and iron-deficiency anemia are common medical conditions. Management of the etiology and iron supplementation are both necessary to treat this condition. Use of intravenous iron preparations is increasing due to its advantages over oral iron. Indeed, the total dose required can be provided in a single infusion, and it is more effective and increases hemoglobin levels more quickly than oral iron. Hypophosphatemia, sometimes severe, following intravenous iron administration, has been described in literature these past years, in particular with ferric carboxymaltose. We report here a case of severe hypophosphatemia with ferric carboxymaltose and carry out a literature review to determine the incidence of hypophosphatemia and to precise its clinical presentation, its pathophysiological mechanisms and its treatment. We found that hypophosphatemia is frequent with ferric carboxymaltose. Most of the time, there are no clinical manifestations, but cases of symptomatic osteomalacia have been described. Duration of hypophosphatemia is variable, from a few weeks to several months in case of prolonged administration. Hypophosphatemia owing to renal phosphate wasting is caused by an increase in intact fibroblast growth factor 23 (FGF-23) levels. However, the mechanism of ferric carboxymaltose- induced increase in intact FGF-23 is still unknown.


Asunto(s)
Anemia Ferropénica , Hipofosfatemia , Administración Intravenosa , Anemia Ferropénica/tratamiento farmacológico , Factor-23 de Crecimiento de Fibroblastos , Humanos , Hipofosfatemia/inducido químicamente , Infusiones Intravenosas , Hierro
15.
World J Gastroenterol ; 27(17): 2039-2053, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-34007138

RESUMEN

BACKGROUND: High-dose intravenous iron is an effective treatment option for iron deficiency (ID) or ID anaemia (IDA) in inflammatory bowel disease (IBD). However, treatment with ferric carboxymaltose (FCM) has been associated with the development of hypophosphatemia. AIM: To investigate mechanisms behind the development of hypophosphatemia after intravenous iron treatment, and disclose symptoms and clinical manifestations related to hypophosphatemia short-term. METHODS: A prospective observational study of adult IBD patients with ID or IDA was conducted between February 1, 2017 and July 1, 2018 at two separate university hospitals in the southeast region of Norway. Patients received one dose of 1000 mg of either FCM or ferric derisomaltose (FDI) and were followed for an observation period of at least 7 wk. Blood and urine samples were collected for relevant analyses at baseline, week 2 and at week 6. Clinical symptoms were assessed at the same timepoints using a respiratory function test, a visual analogue scale, and a health-related quality of life questionnaire. RESULTS: A total of 106 patients was available for analysis in this study. The FCM treatment group consisted of 52 patients and hypophosphatemia was present in 72.5% of the patients at week 2, and in 21.6% at week 6. In comparison, the FDI treatment group consisted of 54 patients and 11.3% of the patients had hypophosphatemia at week 2, and 3.7% at week 6. The difference in incidence was highly significant at both week 2 and 6 (P < 0.001 and P < 0.013, respectively). We observed a significantly higher mean concentration of intact fibroblast growth factor 23 (P < 0.001), a significant rise in mean urine fractional excretion of phosphate (P = 0.004), a significant decrease of 1,25-dihydroxyvitamin D (P < 0.001) and of ionised calcium levels (P < 0.012) in the FCM-treated patients compared with patients who received FDI. No clinical symptoms could with certainty be related to hypophosphatemia, since neither the respiratory function test, SF-36 (36-item short form health survey) or the visual analogue scale scores resulted in significant differences between patients who developed hypophosphatemia or not. CONCLUSION: Fibroblast growth factor 23 has a key role in FCM induced hypophosphatemia, probably by inducing loss of phosphate in the urine. Short-term clinical impact of hypophosphatemia was not demonstrated.


Asunto(s)
Anemia Ferropénica , Hipofosfatemia , Enfermedades Inflamatorias del Intestino , Adulto , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/etiología , Compuestos Férricos/efectos adversos , Humanos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/diagnóstico , Hipofosfatemia/epidemiología , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Hierro , Noruega , Calidad de Vida
17.
CEN Case Rep ; 10(4): 473-475, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-33715107

RESUMEN

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.


Asunto(s)
Colitis Ulcerosa/complicaciones , Compuestos Férricos/efectos adversos , Hipofosfatemia/inducido químicamente , Maltosa/análogos & derivados , Fosfatos/administración & dosificación , Administración Intravenosa , Adulto , Femenino , Humanos , Hipofosfatemia/tratamiento farmacológico , Hipofosfatemia/orina , Maltosa/efectos adversos
18.
Am J Hematol ; 96(5): 606-616, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33471363

RESUMEN

Phosphorus has an essential role in cellular and extracellular metabolism; maintenance of normal phosphorus homeostasis is critical. Phosphorus homeostasis can be affected by diet and certain medications; some intravenous iron formulations can induce renal phosphate excretion and hypophosphatemia, likely through increasing serum concentrations of intact fibroblast growth factor 23. Case studies provide insights into two types of hypophosphatemia: acute symptomatic and chronic hypophosphatemia, while considering the role of pre-existing conditions and comorbidities, medications, and intravenous iron. This review examines phosphorus homeostasis and hypophosphatemia, with emphasis on effects of iron deficiency and iron replacement using intravenous iron formulations.


Asunto(s)
Hipofosfatemia/etiología , Hierro/efectos adversos , Fósforo/metabolismo , Anemia Hipocrómica/tratamiento farmacológico , Calcitriol/fisiología , Compuestos Férricos/administración & dosificación , Compuestos Férricos/efectos adversos , Compuestos Férricos/farmacología , Factor-23 de Crecimiento de Fibroblastos , Factores de Crecimiento de Fibroblastos/biosíntesis , Factores de Crecimiento de Fibroblastos/genética , Factores de Crecimiento de Fibroblastos/fisiología , Homeostasis/efectos de los fármacos , Homeostasis/fisiología , Humanos , Hipofosfatemia/inducido químicamente , Hipofosfatemia/diagnóstico , Hipofosfatemia/terapia , Infusiones Parenterales , Hierro/administración & dosificación , Deficiencias de Hierro , Riñón/metabolismo , Síndromes de Malabsorción/complicaciones , Maltosa/administración & dosificación , Maltosa/efectos adversos , Maltosa/análogos & derivados , Maltosa/farmacología , Osteomalacia/etiología , Hormona Paratiroidea/fisiología , Fósforo Dietético/farmacocinética
19.
J Oncol Pharm Pract ; 27(2): 494-497, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32660376

RESUMEN

INTRODUCTION: The use of bisphosphonates is increasing, for treatment of hypercalcemia and pain in cancer, and post-menopausal osteoporosis and also to decrease the risk of skeletal morbidity in multiple myeloma and metastatic breast cancer. CASE REPORT: A single dose of zoledronic acid was administered for hypercalcemia in a 54-year-old woman breast cancer patient with extensive bone metastasis. After the first dose, the patient developed symptomatic hypocalcemia.Management and outcome: Simultaneous hypocalcemia, hypophosphatemia, and vitamin D deficiency were detected in the patient. In the symptomatic process, intravenous, then oral replacement was performed. DISCUSSION: There is a need for taking precautionary measures such as vitamin D, serum phosphorus and, calcium monitoring and supplementation to prevent life-threatening complications, such as symptomatic hypocalcemia, especially in populations with vitamin D deficiency like ours.


Asunto(s)
Conservadores de la Densidad Ósea/efectos adversos , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Hipocalcemia/inducido químicamente , Ácido Zoledrónico/efectos adversos , Conservadores de la Densidad Ósea/uso terapéutico , Neoplasias Óseas/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/diagnóstico por imagen , Femenino , Humanos , Hipocalcemia/complicaciones , Hipofosfatemia/inducido químicamente , Hipofosfatemia/tratamiento farmacológico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Deficiencia de Vitamina D/inducido químicamente , Deficiencia de Vitamina D/tratamiento farmacológico , Ácido Zoledrónico/uso terapéutico
20.
BMJ Case Rep ; 13(10)2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33033001

RESUMEN

A 76-year-old woman was treated with oral bisphosphonate, alendronate, for osteoporosis in an outpatient clinic. Routine blood tests 4 months after alendronate prescription surprisingly revealed severe hypophosphataemia. The patient was hospitalised and treated with intravenous and oral phosphate supplements. Alendronate was later reintroduced as treatment for osteoporosis and the patient once again presented with severe hypophosphataemia in subsequent routine blood tests. The patient had only presented with lower extremity pain, muscle weakness and difficulty walking. Blood tests in the emergency department both times reconfirmed severe hypophosphataemia. Plasma (p-)ionised calcium levels were normal or slightly elevated and p-parathyroid hormone levels were normal or slightly suppressed. The p-25-hydroxyvitamin-D and p-creatine were in the normal range. Critical illness, malabsorption, nutritional issues and genetics were reviewed as potential causes but considered unlikely. Phosphate levels were quickly restored each time on replacement therapy and the case was interpreted as bisphosphonate-induced severe hypophosphataemia.


Asunto(s)
Alendronato , Difosfonatos , Hipofosfatemia , Osteoporosis , Anciano , Alendronato/administración & dosificación , Alendronato/efectos adversos , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/efectos adversos , Calcio/sangre , Diagnóstico Diferencial , Difosfonatos/administración & dosificación , Difosfonatos/efectos adversos , Femenino , Evaluación Geriátrica/métodos , Humanos , Hipofosfatemia/sangre , Hipofosfatemia/inducido químicamente , Hipofosfatemia/fisiopatología , Hipofosfatemia/terapia , Osteoporosis/sangre , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Hormona Paratiroidea/sangre , Resultado del Tratamiento , Vitamina D/análogos & derivados , Vitamina D/sangre
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