Abstract: FR-PO0624
Ifosfamide-Induced Fanconi Syndrome Presenting with Severe Electrolyte Wasting: A Diagnostic Challenge
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 2
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Adhikari, Janak, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Sharma, Priyadarshani, Lancaster General Hospital, Lancaster, Pennsylvania, United States
- Matarneh, Ahmad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
Introduction
Ifosfamide is a DNA-alkylating agent used to treat a variety of malignancies including sarcoma, lymphoma, and head and neck cancers. While nephrotoxicity is a recognized side effect, its presentation as Fanconi syndrome,a form of proximal tubular dysfunction leading to generalized solute wasting is rare and often underdiagnosed. Early recognition is essential to avoid severe complications and guide chemotherapy management.
Case Description
29-year-old male with metastatic high-grade osteogenic sarcoma of the proximal tibia presented two days after completing a 5-day course of etoposide and ifosfamide with pleuritic chest pain, paresthesia, tremors, and generalized weakness. Initial labs revealed sodium 132 mmol/L, potassium 2.3 mmol/L, bicarbonate 16 mmol/L, chloride 111 mmol/L, phosphorus 0.8 mg/dL, magnesium 1.7 mg/dL, glucose 119 mg/dL, BUN 22 mg/dL, and creatinine 0.93 mg/dL. Arterial blood gas showed a pH of 7.2 and a base deficit of 4.3. Urinalysis demonstrated glucosuria (>500 mg/dL), mild ketonuria, proteinuria (100 mg/dL), and microscopic hematuria with a specific gravity of 1.017. Complete blood count revealed WBC 0.07 K/uL, hemoglobin 6.1 g/dL, and platelets 12 K/uL.EKG showed anterior ST depressions with negative troponins. Chest CT ruled out pulmonary embolism, and echocardiography revealed a moderate pericardial effusion without tamponade. Infectious workup including cultures and viral/fungal serologies was unremarkable. Abdominal imaging showed normal kidneys without obstruction. Nephrology was consulted for evaluation of persistent electrolyte losses. Given the constellation of normoglycemic glucosuria, hypokalemia, hypophosphatemia, hypomagnesemia, metabolic acidosis, and normal kidney function, a diagnosis of ifosfamide-induced Fanconi syndrome was made. The patient received aggressive electrolyte repletion, and his chemotherapy regimen was adjusted in consultation with oncolog
Discussion
Fanconi syndrome should be considered in patients presenting with unexplained polyuria, electrolyte abnormalities, and normoglycemic glucosuria following ifosfamide therapy. Early recognition and prompt management are essential to avoid life-threatening complications and guide future oncologic treatment decisions. This case highlights the importance of close electrolyte and renal monitoring in patients receiving ifosfamide-based regimens.