Iron Infusions - vs - Phosphate 

MCQ's Challenge

  • 1. Which hormone helps the body absorb phosphate in the gut?

    A) Parathyroid hormone (PTH)
    B) FGF23
    C) 1,25-dihydroxycholecalciferol
    D) 25 hydroxycolecalficerol

  • 2. What is the primary function of FGF23 in the body?

    A) To promote calcium absorption
    B) To regulate phosphate by increasing its excretion in the urine
    C) To help with iron absorption
    D) To stimulate vitamin D activation

  • 3. Which type of iron infusion is most commonly associated with low phosphate levels?

    A) Ferrous sulfate
    B) Ferric carboxymaltose
    C) Iron dextran
    D) Ferric gluconate

  • 4. What impact does high intact FGF23 have on the kidneys?

    A) It reduces phosphate excretion
    B) It promotes phosphate reabsorption
    C) It increases phosphate excretion in the urine
    D) It reduces calcium excretio

  • 5. How does FGF23 affect vitamin D activation?

    A) It increases vitamin D activation
    B) It inhibits vitamin D activation
    C) It has no effect on vitamin D activation
    D) It promotes the breakdown of vitamin D

  • 6. What is the recommended first-line treatment for severe symptomatic low phosphate caused by iron infusions?

    A) Phosphate supplements alone
    B) Calcitriol (activated Vitamin D)
    C) Iron supplements
    D) A high-phosphate diet

  • 7. Why is renal impairment protective against the low phosphate side effect of iron infusions?

    A) The kidneys absorb more phosphate
    B) The kidneys do not excrete phosphate easily in patients with kidney disease
    C) Kidney function enhances FGF23 production
    D) Kidney disease reduces calcium levels in the body

  • 8. What might be a strategy for managing low phosphate in patients needing ongoing iron infusions?

    A) Using only phosphate supplements
    B) Switching to a different iron infusion preparation
    C) Stopping iron infusions altogether
    D) Using calcium supplements

  • Answers

    1.) C) 1,25-dihydroxycholecalciferol (Activated Vitamin D)

    If ever you forget which vitamin D is the active type, or the enzyme which activates it - look for the ROCKET SHIP = NUMBER 1

    1 alpha hydroxylase converts 25 hydroxycolecalficerol to 1,25-dihydroxycholecalciferol by adding hydrogen and oxygen.  1 = ACTIVATE = ROCKET SHIP (lock it in!)

    2.) B) To regulate phosphate by increasing its excretion in the urine

    3.) B) Ferric carboxymaltose

    4.) C) It increases phosphate excretion in the urine

    5.) B) It inhibits vitamin D activation

    6.) B) Calcitriol (activated Vitamin D)

    7.) B) The kidneys do not excrete phosphate easily in patients with kidney disease

    8.) B) Switching to a different iron infusion preparation

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