eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Aluminum: Follow-up

Author: Jose F Bernardo, MD, MPH, FASN, Assistant Professor, Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh
Coauthor(s): Michael R Edwards, MD, Medical Director, Department of Emergency Services, Beebe Medical Center; Barbara Barnett, MD, Associate Program Director, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Oct 14, 2009

Follow-up

Deterrence/Prevention

  • Avoid all aluminum-containing antacids, antiperspirants, dialysate, immunizations, and TPN solutions.

Complications

Prognosis

  • Depending upon the degree of dementia and overall medical frailty of the patient, most improve with deferoxamine therapy. Some patients, however, succumb to their underlying disease processes before any noticeable improvement in mental status or anemia occurs. Whether aluminum toxicity itself is fatal is unknown. Typically, patients' underlying diseases and medical frailty lead to early morbidity and mortality.

Patient Education

  • Educate pregnant and breastfeeding females, and any patient with compromised renal function, about the use of aluminum-containing antacids and the potential dangers of their use and overuse. A safe alternative includes calcium carbonate, such as found in Tums.
  • Educate patients to refrain from driving or operating hazardous machinery if they develop dizziness or impaired vision or hearing during treatment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to educate a pregnant female, particularly in her first trimester, about potential damage to the fetus
  • Misdiagnosing abuse in a child or elderly patient with a pathologic rib fracture when the injury is actually secondary to renal/aluminum osteodystrophy
  • Prescribing an aluminum-containing antacid to a patient with impaired renal function
  • Failure to advise patients to refrain from driving or operating hazardous machinery if dizziness, impaired vision or hearing, or other nervous system dysfunction develops
 


More on Toxicity, Aluminum

Overview: Toxicity, Aluminum
Differential Diagnoses & Workup: Toxicity, Aluminum
Treatment & Medication: Toxicity, Aluminum
Follow-up: Toxicity, Aluminum
References
Further Reading
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References

  1. Jiang HX, Chen LS, Zheng JG, Han S, Tang N, Smith BR. Aluminum-induced effects on Photosystem II photochemistry in citrus leaves assessed by the chlorophyll a fluorescence transient. Tree Physiol. Dec 2008;28(12):1863-71. [Medline].

  2. Verstraeten SV, Aimo L, Oteiza PI. Aluminium and lead: molecular mechanisms of brain toxicity. Arch Toxicol. Nov 2008;82(11):789-802. [Medline].

  3. Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila). Feb 2009;47(2):89-100. [Medline].

  4. Brown RO, Morgan LM, Bhattacharya SK, Johnson PL, Minard G, Dickerson RN. Potential aluminum exposure from parenteral nutrition in patients with acute kidney injury. Ann Pharmacother. Oct 2008;42(10):1410-5. [Medline].

  5. Andrasi E, Pali N, Molnar Z, Kosel S. Brain aluminum, magnesium and phosphorus contents of control and Alzheimer-diseased patients. J Alzheimers Dis. Aug 2005;7(4):273-84. [Medline].

  6. Alfrey AC, LeGendre GR, Kaehny WD. The dialysis encephalopathy syndrome. Possible aluminum intoxication. N Engl J Med. Jan 22 1976;294(4):184-8. [Medline].

  7. Shuchang H, Qiao N, Piye N, Mingwei H, Xiaoshu S, Feng S, et al. Protective effects of gastrodia elata on aluminium-chloride-induced learning impairments and alterations of amino acid neurotransmitter release in adult rats. Restor Neurol Neurosci. 2008;26(6):467-73. [Medline].

  8. Riihimaki V, Valkonen S, Engstrom B, Tossavainen A, Mutanen P, Aitio A. Behavior of aluminum in aluminum welders and manufacturers of aluminum sulfate--impact on biological monitoring. Scand J Work Environ Health. Dec 2008;34(6):451-62. [Medline].

  9. Vasudevaraju P, Govindaraju M, Palanisamy AP, Sambamurti K, Rao KS. Molecular toxicity of aluminium in relation to neurodegeneration. Indian J Med Res. Oct 2008;128(4):545-56. [Medline].

  10. Lemire J, Mailloux R, Puiseux-Dao S, Appanna VD. Aluminum-induced defective mitochondrial metabolism perturbs cytoskeletal dynamics in human astrocytoma cells. J Neurosci Res. May 1 2009;87(6):1474-83. [Medline].

  11. Hernandez G, Bollini A, Huarte M, Bazzoni G, Piehl L, Chiarotto M, et al. In vitro effect of aluminium upon erythrocyte membrane properties. Clin Hemorheol Microcirc. 2008;40(3):191-205. [Medline].

  12. Aspenstrom-Fagerlund B, Sundstrom B, Tallkvist J, Ilbak NG, Glynn AW. Fatty acids increase paracellular absorption of aluminium across Caco-2 cell monolayers. Chem Biol Interact. Oct 7 2009;181(2):272-8. [Medline].

  13. Balasubramanyam A, Sailaja N, Mahboob M, Rahman MF, Hussain SM, Grover P. In vivo genotoxicity assessment of aluminium oxide nanomaterials in rat peripheral blood cells using the comet assay and micronucleus test. Mutagenesis. May 2009;24(3):245-51. [Medline].

  14. Becaria A, Campbell A, Bondy SC. Aluminum as a toxicant. Toxicol Ind Health. Aug 2002;18(7):309-20. [Medline].

  15. Bihaqi SW, Sharma M, Singh AP, Tiwari M. Neuroprotective role of Convolvulus pluricaulis on aluminium induced neurotoxicity in rat brain. J Ethnopharmacol. Jul 30 2009;124(3):409-15. [Medline].

  16. Blaylock RL, Strunecka A. Immune-glutamatergic dysfunction as a central mechanism of the autism spectrum disorders. Curr Med Chem. 2009;16(2):157-70. [Medline].

  17. Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J. Jan 2006;23(1):e3. [Medline].

  18. Bogris SL, Johal NS, Hussein I, Duffy PG, Mushtaq I. Is it safe to use aluminum in the treatment of pediatric hemorrhagic cystitis? A case discussion of aluminum intoxication and review of the literature. J Pediatr Hematol Oncol. Apr 2009;31(4):285-8. [Medline].

  19. Bolt HM, Hengstler JG. Aluminium and lead toxicity revisited: mechanisms explaining the particular sensitivity of the brain to oxidative damage. Arch Toxicol. Nov 2008;82(11):787-8. [Medline].

  20. Campbell, Arezoo. The Potential role of aluminum in Alzheimer's disease. Nephrology Dialysis Transplantation. 2002;17 (suppl 2):17-20.

  21. Candy JM, McArthur FK, Oakley AE. Aluminium accumulation in relation to senile plaque and neurofibrillary tangle formation in the brains of patients with renal failure. J Neurol Sci. Feb 1992;107(2):210-8. [Medline].

  22. Cannata-Andia JB, Fernandez-Martin JL. The clinical impact of aluminium overload in renal failure. Nephrol Dial Transplant. 2002;17 Suppl 2:9-12. [Medline].

  23. Chang TM, Barre P. Effect of desferrioxamine on removal of aluminum and iron by coated charcoal haemoperfusion and haemodialysis. Lancet. Nov 5 1983;2(8358):1051-3. [Medline].

  24. Chappard D, Insalaco P, Audran M. Aluminum osteodystrophy and celiac disease. Calcif Tissue Int. Jan 2004;74(1):122-3. [Medline].

  25. Domingo JL. Reproductive and developmental toxicity of aluminum: a review. Neurotoxicol Teratol. Jul-Aug 1995;17(4):515-21. [Medline].

  26. Drago D, Cavaliere A, Mascetra N, Ciavardelli D, di Ilio C, Zatta P, et al. Aluminum modulates effects of beta amyloid(1-42) on neuronal calcium homeostasis and mitochondria functioning and is altered in a triple transgenic mouse model of Alzheimer's disease. Rejuvenation Res. Oct 2008;11(5):861-71. [Medline].

  27. Drueke TB, Lacour B, Touam M. Effect of aluminum on hematopoiesis. Kidney Int Suppl. Feb 1986;18:S45-8. [Medline].

  28. Exley C, Swarbrick L, Gherardi RK, Authier FJ. A role for the body burden of aluminium in vaccine-associated macrophagic myofasciitis and chronic fatigue syndrome. Med Hypotheses. Feb 2009;72(2):135-9. [Medline].

  29. Friga V, Linos A, Linos DA. Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients?. Nephron. 1997;75(1):48-53. [Medline].

  30. Gilbert-Barness E, Barness LA, Wolff J. Aluminum toxicity. Arch Pediatr Adolesc Med. May 1998;152(5):511-2. [Medline].

  31. Graske A, Thuvander A, Johannisson A, Gadhasson I, Schutz A, Festin R, et al. Influence of aluminium on the immune system--an experimental study on volunteers. Biometals. Jun 2000;13(2):123-33. [Medline].

  32. Gupta VB, Anitha S, Hegde ML, Zecca L, Garruto RM, Ravid R, et al. Aluminium in Alzheimer's disease: are we still at a crossroad?. Cell Mol Life Sci. Jan 2005;62(2):143-58. [Medline].

  33. Hem JD. Geochemistry and aqueous chemistry of aluminum. Kidney Int Suppl. Feb 1986;18:S3-7. [Medline].

  34. Key L, Bell N. Osteomalacia and disorders of vitamin D metabolism. In: Internal Medicine. 4th ed. 1994:1526-1527.

  35. Kosier JH. Aluminum toxicity in the 1990s. ANNA J. Aug 1999;26(4):423-4. [Medline].

  36. Mailloux RJ, Puiseux-Dao S, Appanna VD. Alpha-ketoglutarate abrogates the nuclear localization of HIF-1alpha in aluminum-exposed hepatocytes. Biochimie. Mar 2009;91(3):408-15. [Medline].

  37. Malluche HH, Smith AJ, Abreo K. The use of deferoxamine in the management of aluminium accumulation in bone in patients with renal failure. N Engl J Med. Jul 19 1984;311(3):140-4. [Medline].

  38. McCarthy JT, Milliner DS, Johnson WJ. Clinical experience with desferrioxamine in dialysis patients with aluminium toxicity. Q J Med. Mar 1990;74(275):257-76. [Medline].

  39. Priest ND. The biological behaviour and bioavailability of aluminium in man, with special reference to studies employing aluminium-26 as a tracer: review and study update. J Environ Monit. May 2004;6(5):375-403. [Medline].

  40. Shea TB, Wheeler E, Jung C. Aluminum inhibits neurofilament assembly, cytoskeletal incorporation, and axonal transport. Dynamic nature of aluminum-induced perikaryal neurofilament accumulations as revealed by subunit turnover. Mol Chem Neuropathol. Sep-Dec 1997;32(1-3):17-39. [Medline].

  41. Trapp GA. Interactions of aluminum with cofactors, enzymes, and other proteins. Kidney Int Suppl. Feb 1986;18:S12-6. [Medline].

  42. Ward MK, Feest TG, Ellis HA. Osteomalacic dialysis osteodystrophy: Evidence for a water-borne aetiological agent, probably aluminium. Lancet. Apr 22 1978;1(8069):841-5. [Medline].

  43. Yokel RA, McNamara PJ. Aluminium toxicokinetics: an updated minireview. Pharmacol Toxicol. Apr 2001;88(4):159-67. [Medline].

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Further Reading

Clinical guidelines

K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease.
National Kidney Foundation - Disease Specific Society. 2005 Oct. 121 pages. NGC:005108

Nutrient requirements. In: Safe practices for parenteral nutrition.
American Society for Parenteral and Enteral Nutrition - Professional Association. 2004 Dec. 6 pages. NGC:006440

American Gastroenterological Association Institute medical position statement on the use of gastrointestinal medications in pregnancy.
American Gastroenterological Association Institute - Medical Specialty Society. 2006 Jul. 5 pages. NGC:005090


Clinical trial
Aluminum and Auditory Function in ESRD

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Keywords

aluminum toxicity, hyperaluminosis, aluminum-related illness, aluminum concentration, aluminum intoxication, aluminum clearance, aluminum-related disease, dialysis osteodystrophy, dialysis encephalopathy, aluminum deposition, microcytic anemia, chromophilic cells, basophilic stippling, deferoxamine therapy

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Contributor Information and Disclosures

Author

Jose F Bernardo, MD, MPH, FASN, Assistant Professor, Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh
Jose F Bernardo, MD, MPH, FASN is a member of the following medical societies: American Diabetes Association, American Society of Nephrology, and American Society of Transplantation
Disclosure: Nothing to disclose.

Coauthor(s)

Michael R Edwards, MD, Medical Director, Department of Emergency Services, Beebe Medical Center
Michael R Edwards, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Physician Executives
Disclosure: Nothing to disclose.

Barbara Barnett, MD, Associate Program Director, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine
Barbara Barnett, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Harold L Manning, MD, Associate Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School
Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM, Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center
Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, Shock Society, and Society of Critical Care Medicine
Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

 
 
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