While rare, aluminum poisoning has complex and multidimensional effects, such as inhibition of enzymes, decreased protein and nucleic acid synthesis, altering cell membrane permeability, preventing DNA repair, and increasing reactive oxygen species leading to oxidative stress. Many specific cellular signaling pathways have been identified that are influenced by aluminum.
The signs and symptoms of aluminum toxicity are usually nonspecific. Patients may present with proximal muscle weakness, bone pain, slow wound healing, altered mental status, or premature osteoporosis. If aluminum levels are high, chelating agents such as deferoxamine are used to lower blood levels.
The most common indication for aluminum testing in the clinical laboratory concerns dialysis patients. Dialysis patients will have impaired renal function. Since their kidneys are not healthy, they usually lack the ability to excrete aluminum. In addition to reduced clearance, aluminum toxicity in dialysis patients can also be due to exposure to aluminum salts that are present in dialysis fluid and from the ingestion of aluminum-containing phosphate binders. The process of dialysis is also not very efficient at removing aluminum from plasma. Thankfully, aluminum is now removed from water that is used for dialysis, and non-aluminum-containing phosphate binders are widely available, so aluminum toxicity in dialysis patients is now rare and tends to be limited to patients who received hemodialysis in resource-limited countries or patients with unusual environmental exposures.
Some prosthetic joints contain aluminum, and serum levels can be increased due to these implants.
