Aluminum Toxicity Clinical Presentation

Updated: Mar 24, 2023
  • Author: Jose F Bernardo, MD, MPH, FASN; Chief Editor: Sage W Wiener, MD  more...
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The signs and symptoms of aluminum toxicity are usually nonspecific. Typical presentations in chronic toxicity may include proximal muscle weakness, bone pain, multiple nonhealing fractures, acute or subacute alteration in mental status, and premature osteoporosis. These patients almost always have some degree of kidney disease; most of them have end-stage kidney disease and are on hemodialysis or peritoneal dialysis.

In the past, aluminum toxicity, including osteomalacia, was seen in patients on long-term hemodialysis, due to exposure to dialysate containing high concentrations of aluminum. However, aluminum toxicity is not a concern with modern dialysis protocols, which use water purified with reverse osmosis.

Some of the clinical symptoms of the disease entity reflect the chief complaint. An emergency physician will rarely consider aluminum toxicity as a possible diagnosis in a patient on dialysis who presents with an acute mental status change; however, these patients constitute the specific group most closely associated with the syndrome.

When obtaining the history, ask specifically about the use of oral aluminum hydroxide antacids, particularly if the patient has diminished kidney function but does not undergo dialysis.

A history of long-term total parenteral nutrition (TPN) is also a risk factor. This especially true in infants, as elevated aluminum levels have been found in infant TPN formula. [31]


Physical Examination

Unfortunately, physical findings are often noticeably lacking in patients with aluminum toxicity, and findings usually mimic other disease processes.

Patients can present with multiple fractures (particularly of the ribs and pelvis), proximal muscle weakness, mutism, seizures, and dementia.

Some studies have shown a direct correlation between aluminum levels and intensity of uremic pruritus. [36]

In children, bony deformity is more commonly due to the increased rate of growth and remodeling. The areas of deformity in children usually involve the epiphyseal plates (ie, femur, wrist).Children may also demonstrate varying degrees of growth retardation. In adults, thoracic cage abnormalities, lumbar scoliosis, and kyphosis can be present.