Prevention and Management of Al Intoxication

Because Al toxicity is a serious iatrogen complication, any preventive measures to avoid exposure to Al is incumbent. Unfortunately, with the current treatment practices, there continues to be a risk that patients receive excessive amounts of Al orally or parenterally. If Al compounds cannot be avoided in patients with renal failure, routine Al tests performed every 3-4 months in serum will identify persons at greatest risk (s-Al levels 100 to 150 pg/L) for chronic Al intoxication. Ideally, any patient with s-Al higher than 40 to 50 pg/L should discontinue Al gels and use other substitutes. These patients should also be warned not to ingest these compounds with liquids containing citrate, for example, fruit juices. 

Hemodialysis patients in dialysis centers or on home hemodialysis generally will be protected from Al intoxications by the combination of deionization and RO devices. Nevertheless, one should realize that the composition of the dialysate is a combination of normal drinking water according to WHO guidelines and extended water purification. Drinking water conditions can change unexpectedly and erratically at the water plant as well as in the water 

At the start of therapy one should identify and eliminate the source or sources of the Al. Up to date, desferrioxamine is the hallmark of therapy for Al intoxication [260-273]. 

---