Aluminum toxicity

Aluminum Metal

• Dusts cause respiratory tract and eye irritation
• Acute exposures can cause bronchoconstriction and asthma-like response
• Chronic exposure can lead to pulmonary fibrosis
• Increased incidence of cancer

Aluminum phosphide

• Used as a fumigant
• Contact with moisture produces phosphine gas
• Respiratory tract irritant

Aluminum oxide

• Physical irritant, nuisance particulate

Systemic aluminum toxicity

• Usually in renal patients on long-term dialysis with aluminum-containing dialysate
• Rarely acute
• Muscle weakness (especially proximal)
• Premature osteoporosis, bone pain, multiple fractures
• Seziures
• Acute or subacute altered mental status

Differential Diagnosis

• Aluminum toxicity
• Antimony toxicity
• Arsenic toxicity
• Barium toxicity
• Beryllium toxicity
• Bismuth toxicity
• Boron toxicity
• Cadmium toxicity
• Cesium toxicity
• Chromium toxicity
• Cobalt toxicity
• Copper toxicity
• Gold toxicity
• Iron toxicity
• Lead toxicity
• Lithium toxicity
• Manganese toxicity
• Mercury toxicity
• Nickel toxicity
• Phosphorus toxicity
• Platinum toxicity
• Selenium toxicity
• Silver toxicity
• Thallium toxicity
• Tin toxicity
• Vanadium toxicity
• Zinc toxicity

Evaluation

• Aluminum level > 50 µg/L (mcg/dL) suggests aluminum overload and possible toxicity
  • Symptomatic patients with levels 20-50 may also need treatment

Management

• Stop exposure
• Supportive care is the cornerstone of treatment, particularly in mild cases. This includes respiratory support (e.g., bronchodilators for bronchospasm) and symptomatic treatment of neurological or musculoskeletal manifestations.
• Chelation therapy:
  • Deferoxamine is the chelator of choice for aluminum toxicity. It binds free aluminum, forming a water-soluble complex (aluminoxamine) excreted by the kidneys.
  • Indications include: symptomatic patients with serum aluminum >50 µg/L, or any patient with encephalopathy, bone disease, or anemia attributed to aluminum.
  • Use with caution in patients with renal impairment, as deferoxamine-aluminum complexes require adequate renal clearance; dialysis may be needed to remove the chelated complex.
• Dialysis: Consider hemodialysis in patients with renal failure and aluminum overload, particularly if encephalopathy is present or if chelation is being performed.
• Avoidance of aluminum-containing medications, including phosphate binders, IV fluids, or antacids, is important during and after treatment.

Disposition

Admission Criteria

Symptomatic patients (e.g., altered mental status, seizures, severe bone pain).

Known or suspected aluminum overload in the setting of renal failure.

Patients requiring chelation or dialysis should be admitted for monitoring and treatment.

Outpatient Management

Asymptomatic patients with mild elevations (e.g., <50 µg/L) and no risk factors (e.g., normal renal function) may be monitored closely with repeat labs and exposure cessation.

Follow-up

Patients with chronic exposure or prior toxicity should be referred for occupational medicine or toxicology evaluation.

Renal patients should have their dialysis fluids and medications reviewed for aluminum content.

Bone health monitoring may be warranted in those with chronic exposure or symptoms suggestive of osteomalacia or osteoporosis.

See Also

• Toxicology (main)