Aluminum Toxicity Treatment & Management

Updated: Jan 23, 2021
  • Author: Jose F Bernardo, MD, MPH, FASN; Chief Editor: Sage W Wiener, MD  more...
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Treatment

Medical Care

The most important part of emergency medical treatment is the recognition of possible aluminum toxicity based on risks (eg, renal insufficiency, aluminum exposure) and symptoms (eg, altered mental status, anemia, osteoporosis).

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. Serum aluminum level greater than 50-60 µg/L (mcg/dL) suggests aluminum overload, may correlate with toxicity, and can be used as an indication to start chelation therapy in symptomatic patients. Symptomatic patients with lower serum aluminum levels (eg, greater than 20 mcg/dL) may require chelation therapy.

Kan et al suggested that a low dose of deferoxamine therapy (2.5 mg/kg/wk) is therapeutically effective as standard dose (5 mg/kg/wk) for the treatment of aluminum overload. [32]

Chelation therapy with deferoxamine should be initiated in consultation with a nephrologist and a medical toxicologist, and this can be performed upon admission. 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. Use clinical symptoms and serum aluminum levels as indicators of therapeutic success. 

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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Surgical Care

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

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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.

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Diet

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

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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.

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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). [33]

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. [33]

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