Scientific Poster Session IV - Case Reports

Abstract

Intravenous (IV) iron products are widely used for iron repletion, and all products are associated serious hypersensitivity reactions including anaphylactic-type reactions. Newer formulations, such as sodium ferric gluconate (SFG), are reported to be safer than iron dextran with fewer than 1% of patients experiencing reactions precluding further administration.

Case:

During a 5-week span with 159 administrations, six IV SFG doses resulted in serious adverse reactions (3.8%). Every patient received SFG 250mg in 100mL of 0.9% sodium chloride administered over 60 minutes. Five patients experienced an infusion-related reaction with the first dose of IV SFG, and the sixth patient experienced a reaction upon receiving the third dose. Four patients required escalation of care including initiation of vasoactive agents or transfer to intensive care. Medications administered included: IV diphenhydramine (5) corticosteroids (4), famotidine (4), fluid bolus (3), intramuscular epinephrine (2), initiation or uptitration of vasopressors (2), inhaled racemic epinephrine (1), and albuterol nebulizations (1). Additionally, a non-rebreather, emergent intubation, and intra-arterial balloon pump placement were required in one patient each. Four patients tolerated subsequent doses of IV iron sucrose without complications.

Discussion:

The use of IV SFG resulted in rates of serious adverse events similar to that of IV iron dextran at our institution. The use of IV SFG is largely documented in patients with kidney disease with maximum doses of 125mg given IV push or over 30 – 60 minutes, which was a lower dose than administered to our patients. Additionally, three of our patients had extensive cardiovascular disease and all patients were acutely ill, which represent a population not evaluated in the current literature.

Conclusion:

Higher than expected severe adverse drug reactions occurred after the administration of IV SFG during hospital admissions. Further studies are needed to determine if IV SFG administration is safe for indications other than kidney disease.

Presenting Author

Authors