eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Aluminum: Treatment & Medication

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

Treatment

Medical Care

Treatment of aluminum toxicity includes elimination of aluminum from the diet, TPN, dialysate, medications, antiperspirants, and an attempt at the elimination and chelation of the element from the body's stores.
  • Avoidance of aluminum is easily achieved once the need to do so is recognized.
  • Elimination is accomplished through the administration of deferoxamine through any of several routes.
    • Deferoxamine, the metal-free ligand of the iron-chelate isolated from the bacterium Streptomyces pilosus, is used for acute and chronic iron toxicity and aluminum toxicity.
    • It has a high affinity for ferric iron and does not affect iron in hemoglobin or cytochromes.

Surgical Care

No surgical care is applicable to this disorder. Hemodialysis is performed in conjunction with deferoxamine as therapy for whole body chelation

Consultations

  • Usually, a nephrologist is already a part of the patient's medical team. If not, one should be consulted early in the course.
  • A hematologist and a neurologist may be able to assist with the patient's care.

Diet

Since dietary aluminum is ubiquitous, there are no specific dietary guidelines for its avoidance. Special diets should be maintained for specific associated disease entities (eg, diabetes, renal failure).

Activity

Activity modification may not be necessary unless the patient is at risk for frequent falls. If this is the case, a home attendant or family member should assist the patient with daily living activities.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Metal chelators

Bind free metal and do not chelate other trace metals of nutritional importance. Metals are excreted in the urine and bile.


Deferoxamine mesylate (Desferal mesylate)

Metal-free ligand of the iron chelate isolated from the bacterium S pilosus. Used for acute and chronic iron toxicity as well as aluminum toxicity and has a high affinity for ferric iron. Does not affect iron in cytochromes or hemoglobin. PO/IM administration not established. Several case reports and cohorts using varying doses indicate effectiveness when administered IV.

Adult

6 g/wk average at 14.5 mg/kg/h IV 3 times/wk during first 2 h of dialysis or 85 mg/kg/wk at 14.5 mg/kg/h IV
CAPD: 500-750 mg added to each 2-L bag of dialysate for approximately 2 mo; varying amount of exchanges using deferoxamine (eg, only hs, once/d) would prolong therapy; alternatively, administer prolonged SC infusion over 8-16 h via pump

Pediatric

Not established; consult nephrologist

Vitamin C >500 mg/d can cause cardiac dysfunction; concomitant administration with prochlorperazine can cause transient loss of consciousness; gallium-67 scanning results can be affected

Documented hypersensitivity, profound hypotension, anuria, and severe renal disease without ability to dialyze

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Tachycardia, hypotension, and shock may occur in patients receiving long-term therapy and could add to the cardiovascular collapse due to iron toxicity; adverse GI effects of the drug include abdominal discomfort, nausea, vomiting, and diarrhea, which may add to the symptoms of acute iron toxicity; flushing and fever are reported

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

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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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