Reactions 1480, p16 - 30 Nov 2013

SDeferasirox

Hyperchloraemic metabolic acidosis: case reportAn adolescent female patient developed hyperchloraemic

metabolic acidosis during treatment with deferasirox for β-thalassaemia major.

The girl was 17 years old when she was initiated on oraldeferasirox therapy at 20mg/kg of body weight and displayedno adverse effects before her dose was increased to 30mg/kgof body weight daily. Eight months later, she presented with a2-day history of mild abdominal pain, nausea and vomiting.Her pulse oximetry, heart rate, blood pressure and axillarybody temperature were all normal and her mucousmembranes were slightly dry. Her laboratory results showedthe following: haemoglobin 91 g/L, ferritin 935 µg/L, totalbilirubin 24µM, ALT 37 U/L , AST 43 U/L, chloride 111mM,venous pH 7.23, partial pressure of carbon dioxide 32mm Hg,and bicarbonate 12.9mM. Her tendency towardshyperchloraemic metabolic acidosis persisted after correctionof fluid volume depletion.

Deferasirox was stopped and the patient was treated withsodium bicarbonate which corrected her acidosis. Alkalitherapy was stopped 2 months later at which time herlaboratory values were normal. She was subsequently treatedwith oral deferiprone and subcutaneous deferoxamine.

Author comment: "The Naranjo scale was used to assessthe probability that deferasirox caused the patient to havemetabolic acidosis and not other factors. Based on this scale,there is a probable association between deferasirox and thedevelopment of acidosis."Dell·Orto VG, et al. Hyperchloraemic metabolic acidosis induced by the ironchelator deferasirox: A case report and review of the literature. Journal of ClinicalPharmacy and Therapeutics 38: 526-527, No. 6, Dec 2013. Available from: URL:http://dx.doi.org/10.1111/jcpt.12095 - Switzerland 803096100

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Reactions 30 Nov 2013 No. 14800114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved