aluminum toxicity

Epidemiology

• dietary aluminum is ubiquitous in small quantities
• not a significant concern in subjects with normal renal function
• identified as a source of concern in dialysis patients using tap water in dialyis solutions
• acute toxicity is rare

Pathology

• causes oxidative stress in the brain
• interferes with neurofilament axonal transport & neurofilament assembly

Clinical manifestations

• dementia
• microcytic anemia
• bone pain, multiple fractures
• proximal myopathy

Pharmacokinetics

• 0.3% of orally administered aluminum is absorbed via the GI tract
• PTH may increase intestinal absorption of aluminum
• 95% of an aluminum load is bound to transferrin & albumin intravascularly & is then eliminated renally
• 1/2life in brain is 7 years

Laboratory

• aluminum in specimen
  • aluminum in air
  • aluminum in hair
  • aluminum in water
  • aluminum in tissue
  • aluminum in erythrocytes
  • aluminum in body fluid
    • aluminum in blood
    • aluminum in CSF
    • aluminum in dialysis fluid
    • aluminum in serum/plasma
      • serum aluminum > 20 ug/dL
      • serum aluminum > 50 ug/dL is an indication for chelation therapy in symptomatic patients
    • aluminum in urine

Management

• elimination of aluminum from the diet, TPN, dialysate, medications, antiperspirants
• chelation therapy with deferoxamine 2.5-5.0 mg/kg/wk
• nephrology consult

More general terms

• toxicity; poisoning; overdose

Additional terms

• aluminum [Al]