OVERVIEW

What is aluminum poisoning?

Aluminum poisoning refers to the abnormal functioning of various body systems caused by the accumulation of excessive aluminum in the body through ingestion, inhalation, or other pathways.

What are the characteristics of aluminum poisoning?

Aluminum poisoning is mostly chronic, with nonspecific early symptoms that are difficult to detect and often overlooked. The most common damages include brain neuropathy, anemia, and bone diseases, which may occur individually or coexist.

What are the symptoms of aluminum poisoning?

Common symptoms include loss of appetite, fatigue, depression, and dizziness. This condition is frequently observed in hemodialysis patients.

What are the consequences of aluminum poisoning?

Only a small amount of ingested aluminum is excreted, while most accumulates in the body, binding to proteins or enzymes and disrupting biochemical reactions. Organs like the brain are highly sensitive to aluminum and prone to damage, leading to symptoms. Long-term excessive intake may cause irreversible brain damage and dementia. Some organs, such as the liver, can tolerate higher aluminum concentrations without showing toxicity.

SYMPTOMS

What are the common manifestations of aluminum poisoning?

• Harm to the nervous system: Long-term accumulation of large amounts of aluminum in brain tissue can significantly affect the morphology and function of nerve cells, leading to speech deterioration, slowed movement, memory loss, attention deficits, stuttering, epilepsy, mental abnormalities, and may even induce Alzheimer's disease. Once neurological damage occurs, the condition often progresses continuously.

• Harm to the digestive system: Aluminum-based medications are often used to treat peptic ulcers or excessive stomach acid, but long-term and excessive use can easily trigger symptoms such as intestinal obstruction and constipation.

• Harm to the immune system: Aluminum has a significant inhibitory effect on immune system function, primarily by interfering with the number and transformation of T lymphocytes, cell proliferation, and other aspects of human immune function.

• Harm to the reproductive system: Aluminum can cross the placental barrier and accumulate in the fetus, leading to abnormal embryonic development, fetal malformations, or developmental disorders. It can also inhibit the activity of various enzymes in the reproductive system, resulting in suppressed reproductive function.

• Harm to the blood system: Aluminum poisoning can cause non-iron-deficient microcytic hypochromic anemia and renal anemia. On one hand, it inhibits the activity of ferroxidase and binds to transferrin, affecting iron utilization. On the other hand, aluminum can interfere with heme synthesis by affecting the activity of δ-aminolevulinic acid dehydratase.

• Harm to the bones: The histological damage to the skeletal system caused by aluminum poisoning mainly manifests as osteomalacia and osteodystrophy. Aluminum directly impairs osteoblast activity, affects the proliferation and function of osteoblasts and osteoclasts, and interferes with calcium ion absorption, leading to osteoporosis and hypophosphatemia.

CAUSES

Under what circumstances does aluminum poisoning occur?

• Patients with renal insufficiency have reduced kidney function, leading to decreased aluminum excretion and increased accumulation in the body.

• Long-term dialysis patients are susceptible to contamination from aluminum-containing materials (such as tubing and consumables) during dialysis, and due to loss of kidney function, the aluminum cannot be excreted, resulting in poisoning.

• Long-term excessive intake of certain aluminum-containing medications, such as phosphate-lowering drugs (e.g., aluminum hydroxide) taken by uremic patients, or gastric mucosal protectants (e.g., magnesium aluminum carbonate tablets) commonly used by patients with peptic ulcers.

• Long-term excessive consumption of aluminum-containing foods or supplements, such as fried dough sticks, jelly noodles, vermicelli, or leavening agents (e.g., alum) added to puffed foods.

• Long-term use of aluminum containers.

DIAGNOSIS

When should one be alert to aluminum poisoning?

Patients with long-term exposure to aluminum metal, prolonged use of aluminum-containing medications or foods, and impaired kidney function should be vigilant for aluminum poisoning. Symptoms such as loss of appetite, fatigue, depression, memory decline, and anemia may indicate potential aluminum poisoning.

What tests should be done for aluminum poisoning? What abnormalities might the results show?

Serum aluminum levels should be monitored. In healthy individuals, serum aluminum concentration is typically below 10 ug/L, while most hemodialysis patients may have levels up to 100 ug/L. Serum aluminum exceeding 100 ug/L may lead to bone and neurological damage, and levels above 190 ug/L can trigger clinical poisoning symptoms at any time.

TREATMENT

Which department should I visit for aluminum poisoning?

For aluminum poisoning, you can generally visit general practice, general internal medicine, occupational disease hospital poisoning clinics, or gastroenterology. Hemodialysis patients are usually treated in the nephrology department.

What should I do for aluminum poisoning?

• Identify the source of aluminum and stop consuming aluminum-containing foods or medications. For inhalation poisoning, oxygen therapy is required, and glucocorticoids or sodium bicarbonate may be administered via nebulization if necessary. In cases of pulmonary edema, intravenous glucocorticoids may also be considered.

• Aluminum poisoning primarily relies on the body's natural elimination of aluminum, so efforts should be made to promote bowel movements and urination.

• During dialysis, medical staff should take precautions to prevent aluminum contamination when operating equipment and preparing solutions. Dialysate should be regularly monitored for aluminum levels, and if exceeded, the source of contamination should be identified and avoided.

• For aluminum poisoning caused by hemodialysis, high-flux dialysis can be used for intensive treatment (6 days per week).

• Deferoxamine therapy may be administered.

DIET & LIFESTYLE

What should patients with aluminum poisoning pay attention to in daily life?

• Avoid contact and use of aluminum-containing containers, food, and medications.

• Prevent indigestion and maintain regular bowel movements to reduce aluminum absorption.

• Drink more water and urinate frequently to promote aluminum excretion.

• Ensure good ventilation in workplaces with aluminum exposure.

PREVENTION

How to Prevent Aluminum Poisoning?

• Avoid using aluminum products in daily life as much as possible.

• Reduce consumption of foods containing aluminum salt additives (such as alum, sodium aluminum phosphate, etc.).

• Patients with stomach issues should minimize the use of antacids containing aluminum, such as aluminum hydroxide.

• Limit intake of foods and herbs high in aluminum, including fried dough sticks, spinach, whole wheat bread, black pepper, bay leaves, cinnamon, thyme, sage, and perilla.

• Peritoneal dialysis patients should regularly monitor serum aluminum levels and dialysis fluid aluminum concentration, replacing the dialysis fluid if necessary.