High serum aluminium levels and acute reversible encephalopathy in a 4-year-old boy with acute renal failure

Abstract

We report a 4-year-old boy, in acute renal failure, who had acute encephalopathy with very high serum aluminium levels (135 micrograms/l [5 mumol/l]) after receiving vesical irrigations with alum. We believe that in situations of non-focal neurological deterioration with no apparent cause in patients with impaired renal function receiving aluminium-containing preparations, the possibility of acute aluminium poisoning should be considered.

Aluminum toxicity in childhood

“…It took 45 days for the aluminum levels in serum to return to normal, implying that his tissues had been loaded. The child recovered without any form of chelation [40]. An important point about this child is that the acute aluminum toxicity presented as obtundation and seizures rather than dementia.…”

“…A recent report by Moreno et al [40] describes acute aluminum toxicity secondary to bladder irrigations with aluminum sulfate in a 4-year-old boy with rhabdomyosarcoma who had developed renal failure and hemorrhagic cystitis after ifosfamide. His serum aluminum level was documented at 135 ~tg/1 (normal <10 pg/l) at the time he became encephalopathic and developed seizures.…”

“…The American Academy of Pediatrics and the Food and Drug Administration recommend decreased exposure to aluminum from antacids and parenterally administered solutions [23,45]. Unexpected aluminum toxicity from bladder irrigations [40] and previous poorly recognized aluminum-containing medications (Kaopectate) can be treated simply by stopping the aluminum. At the November 1991 American Society of Ntphrology meeting, Dr. Jack Coburn stated that the severe complications of deferoxamine therapy including death from infections such as Yersinia and Rhizopus can cause fatality in approximately 30% of patients, and, therefore, the first line of therapy for aluminum toxicity should always be to stop all the known aluminum exposure, even though aluminum is occasionally unavoidable as a contaminant.…”

In vivo antiplatelet effect of intravenous alum in rabbits

“…Intact renal function is essential for rapid disposal of a parenteral aluminium dose [24]. Therefore, patients with renal impairment are at increased risk of developing encephalopathy, which might be a major drawback against routine use of alum [2,25].…”