Burwen DR, Olsen St, Bland LA, Arduino MJ, Reid MH, Jarvis WR
Epidemic aluminum intoxication in hemodialysis patients traced
to use of an aluminum pump
Kidney Int
(Aug) 48:469-474 1995
This is a CDC case control study of elevated serum aluminum
levels (>100 ug/liter, often 300-500, sometimes > 500 ug/liter) which
occurred in 1991 in patients treated at a dialysis unit in
Pennsylvania. Many of the patients had mental status changes and other
neurologic symptoms. The problem was traced to an aluminum pump used
to pump concentrate from a storage tank. As long as acetate
concentrate was used, the problem appeared to be minimal. However,
after switching to bicarbonate dialysate, when the pump was used to
move acid concentrate, high patient aluminum levels and symptoms of
aluminum intoxication increased dramatically in frequency. In vitro
testing of the pump confirmed leaching of large amounts of aluminum
from the pump into acid concentrate. Replacing the aluminum pump with
one made of plastic solved the problem. Continued vigilance about
occult sources of aluminum exposure in dialysis patients is warranted.
(Daugirdas)
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