Aluminum Toxicity Follow-up

Updated: Apr 15, 2015
  • Author: Jose F Bernardo, MD, MPH; Chief Editor: Asim Tarabar, MD  more...
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Follow-up

Further Inpatient Care

Start chelation therapy in symptomatic patients with elevated serum aluminum level in consultation with a nephrologist and a medical toxicologist. Use clinical symptoms and serum aluminum levels as indicators of therapeutic success. Reduce exposure to aluminum-containing products.

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Transfer

If chelation therapy and hemodialysis/peritoneal dialysis are not able to be provided, transfer the patient to an institution with a higher level of care.

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Deterrence/Prevention

Avoid all aluminum-containing antacids, antiperspirants, dialysate, immunizations, and total parenteral nutrition (TPN) solutions.

Many dialysis units routinely measure aluminum levels in their patients, because excessive aluminum in dialysate has historically been a cause of toxicity. However, modern reverse osmosis water should be aluminum free. A single-center retrospective Australian study found that although aluminum levels in feed water were sometimes as high as 48 μmol/L, after reverse osmosis, aluminum was almost always undetectable (< 0.1 μmol/L). [28]

The study also included 2058 plasma aluminum tests performed between 2010 and 2013 in 755 patients (61.9% male, mean age of 64.7 years), and found that the mean level was 0.41 ± 0.30 μmol/L. Aluminum levels were >0.74 μmol/L in 111 tests from 61 patients, 45 of whom (73.8%) had been prescribed aluminum hydroxide as a phosphate binder. The authors concluded that routine testing of plasma aluminum in dialysis patients appears unnecessary and selective testing should be considered. [28]

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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.

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Patient Education

Educate pregnant and breastfeeding females, and any patient with compromised renal function, about the potential dangers associated with the use and overuse of aluminum-containing antacids. 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.

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