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.