Aluminum Toxicity

Aluminum Toxicity – Treatment Overview

Introduction
Aluminum toxicity is a clinical condition caused by excess accumulation of aluminum in the body, most often in patients with chronic kidney disease (CKD) exposed to aluminum-containing phosphate binders, contaminated dialysate, or parenteral nutrition. It can also occur with excessive occupational exposure. Clinical features include:

• Skeletal: Osteomalacia, bone pain, fractures.

• Neurological: Encephalopathy, speech disorders, seizures, dementia-like symptoms.

• Hematological: Microcytic anemia resistant to iron therapy.

Management involves removal of the source of aluminum exposure, chelation therapy, and supportive care.

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Treatment Options and Doses

1. Elimination of Aluminum Exposure

• Stop aluminum-containing medications (e.g., aluminum hydroxide antacids, phosphate binders).

• Use non-aluminum phosphate binders (e.g., sevelamer, lanthanum, calcium carbonate).

• Ensure dialysis fluid is free of aluminum contamination.

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2. Chelation Therapy

• Deferoxamine (DFO) – the primary chelating agent.

  • Dose: 5 mg/kg IV once weekly (infused slowly over 1–2 hours after dialysis in hemodialysis patients).

  • Mechanism: Binds aluminum to form aluminoxamine, which is excreted by the kidneys or removed by dialysis.

  • Used in symptomatic patients or those with elevated serum aluminum levels.

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3. Dialysis Support

• Adequate and high-flux hemodialysis to enhance aluminum clearance, especially after deferoxamine infusion.

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4. Symptomatic and Supportive Management

• Bone disease: Vitamin D supplementation (e.g., calcitriol), phosphate control, fracture management.

• Neurological complications: Seizure control (e.g., levetiracetam, valproate) if required.

• Anemia: Erythropoietin-stimulating agents (ESAs) may improve response after reducing aluminum load.

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Monitoring

• Serum aluminum levels: Elevated if >60 µg/L; toxic if >200 µg/L.

• Bone biopsy: May be considered in cases of suspected aluminum-related osteomalacia.

• Clinical monitoring: Neurological status, bone health, hemoglobin response to ESA therapy.