From the Guidelines
Aluminum oxalate toxicity presents with symptoms similar to other aluminum poisoning cases, including gastrointestinal distress, neurological symptoms, bone pain, and kidney dysfunction, and requires prompt treatment with chelation therapy and supportive care to prevent long-term morbidity and mortality. The symptoms of aluminum oxalate toxicity can be diverse, ranging from early signs such as nausea, vomiting, and abdominal pain, to more severe neurological symptoms including confusion, memory problems, speech disturbances, muscle weakness, and coordination difficulties 1. Bone pain and fractures can occur with chronic exposure due to aluminum's interference with calcium metabolism, and anemia resistant to treatment may develop as aluminum disrupts red blood cell production 1. Kidney dysfunction is common, manifesting as decreased urine output or changes in urination patterns, and respiratory issues like shortness of breath may occur in severe cases.
The treatment of aluminum oxalate toxicity typically involves supportive care and chelation therapy with medications like deferoxamine (typical dose 5-15 mg/kg/hour IV) to bind and remove aluminum from the body 1. However, to avoid DFO-induced neurotoxicity in patients with serum aluminum >200g/L, DFO should not be given until intensive dialysis (6 days per week) with high-flux dialysis membrane and a dialysate aluminum level of <5g/L and until the pre-dialysis serum aluminum level has been reduced to <200g/L 1. Hemodialysis may be necessary in severe cases, particularly with kidney involvement. It is essential to maintain a dialysate concentration of aluminum at <10g/L to prevent aluminum toxicity 1.
Key considerations in managing aluminum oxalate toxicity include:
- Early recognition of symptoms to initiate prompt treatment
- Use of chelation therapy with deferoxamine
- Avoidance of DFO-induced neurotoxicity by careful monitoring of serum aluminum levels
- Maintenance of adequate dialysate aluminum levels
- Supportive care to manage symptoms and prevent complications.
By prioritizing these considerations, healthcare providers can effectively manage aluminum oxalate toxicity and improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Signs and Symptoms of Aluminum Oxalate Toxicity
- The signs and symptoms of aluminum toxicity include disabling osteomalacia, encephalopathy, and anemia 2
- Clinical disturbances associated with aluminum toxicity are a microcytic anaemia and metastatic extraskeletal calcification 3
- Aluminum overload can cause dialysis encephalopathy syndrome and an osteomalacic component of dialysis osteodystrophy 3
- Acute toxicity studies of aluminum compounds have shown clinical and physical signs including lethargy, decreased locomotor activity, piloerection, weight loss, and perorbital bleeding 4
- Aluminum toxicity is also associated with decreased bone turnover and a relative parathyroid hormone (PTH) deficiency 5
Treatment and Management
- Chelation therapy with desferrioxamine and haemodialysis can effectively treat aluminum overload 3
- Deferoxamine mesylate, a heavy metal chelating agent, is used to remove aluminum from the tissues of dialysis patients 2
- Malic, succinic, oxalic, and malonic acids have shown efficacy in treating acute aluminum toxicity 4