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aluminum toxicity
Epidemiology:
- dietary aluminum is ubiquitous in small quantities
- not a significant concern in subjects with normal renal function
- identified as a source of concern in dialysis patients using tap water in dialyis solutions
- acute toxicity is rare
Pathology:
- causes oxidative stress in the brain
- interferes with neurofilament axonal transport & neurofilament assembly
Clinical manifestations:
- dementia
- microcytic anemia
- bone pain, multiple fractures
- proximal myopathy
Pharmacokinetics:
- 0.3% of orally administered aluminum is absorbed via the GI tract
- PTH may increase intestinal absorption of aluminum
- 95% of an aluminum load is bound to transferrin & albumin intravascularly & is then eliminated renally
- 1/2life in brain is 7 years
Laboratory:
- aluminum in specimen
- aluminum in air
- aluminum in hair
- aluminum in water
- aluminum in tissue
- aluminum in erythrocytes
- aluminum in body fluid
- aluminum in blood
- aluminum in CSF
- aluminum in dialysis fluid
- aluminum in serum/plasma
- serum aluminum > 20 ug/dL
- serum aluminum > 50 ug/dL is an indication for chelation therapy in symptomatic patients
- aluminum in urine
Management:
- elimination of aluminum from the diet, TPN, dialysate, medications, antiperspirants
- chelation therapy with deferoxamine 2.5-5.0 mg/kg/wk
- nephrology consult
Related
aluminum [Al]
General
toxicity; poisoning; overdose
References
- Bernardo JF et al
eMedicine: Toxicity, Aluminum
http://emedicine.medscape.com/article/165315-overview