Aluminum - much ado about something
Article Abstract:
The buildup of calcium phosphate deposits is a complication of dialysis (passage of body fluids through a membrane to filter out waste products from the blood), which can be prevented or treated by the administration of aluminum salts. However, these products have their own serious side effects: dementia and bone changes associated with fractures (osteomalacia). Patients are now routinely monitored for toxic aluminum levels, and aluminum doses, in either the dialyzing fluid or oral formulations, have been reduced. An article in the February 21, 1991 issue of The New England Journal of Medicine reports that even the commonly accepted doses of aluminum cause accumulation of the metal in the body. In this study, children and young adults underwent a doubling of their blood aluminum levels after one year of treatment, which reached a level associated with illness and even death. If there is a safe dose of aluminum, these patients should receive it, and then should be closely watched. Other factors, such as drug therapy, can increase aluminum absorption or toxicity. The case of one dialysis patient who developed very high blood aluminum levels is discussed: efforts to discover the source of excess aluminum in his diet were unsuccessful until it was discovered that he consumed large amounts of an over-the-counter pain medication containing citrate (Alka-Seltzer). The patient died one week despite discontinuation of both the aluminum and the citrate. Whether aluminum toxicity impairs the health of the general population is an important question; people with Alzheimer's disease have high levels of aluminum in their brains. However, several points argue against aluminum as a major cause of dementia, except in dialysis patients; these are enumerated. A more important concern is the high level of aluminum in some commercially available fluids for parenteral nutrition (intravenous feeding). These should be regulated by the Food and Drug Administration, or by the manufacturers. The more that is learned about the toxicity of aluminum in dialysis patients, the less its use seems justified. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1991
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Sucralfate, intestinal aluminum absorption, and aluminum toxicity in a patient on dialysis
Article Abstract:
Aluminum is retained by individuals with impaired kidney function, which can lead to osteomalacia (softening of the bone with symptoms of weakness, pain, weight loss and bone fracture) and encephalopathy (an abnormal condition of the structure or function of the tissues of the brain). The use of antacids that contain aluminum is often a source of aluminum in patients with renal failure who are on dialysis. Sucralfate is an nonantacid that is commonly used to treat peptic ulcers and gastritis (inflammation of the gastrointestinal system), which contains large quantities of aluminum. A case study is presented of an individual with end-stage renal failure, who was given sucralfate to treat gastritis. Recurrent seizures and bone pain developed and the individual was diagnosed as having aluminum-related osteomalacia. A study revealed that the absorption of aluminum increases during treatment with sucralfate, as seen by an increase in aluminum in the urine but not in the blood. (Analysis of the levels of aluminum in the urine is much more sensitive than in the blood to determine how much aluminum has been absorbed.) Caution should be taken when patients with renal disease are treated with the nonantacid drug sucralfate for ulcers or gastritis; such treatment should be for only short periods of time only. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1989
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