SHM Converge Scientific Abstract ePoster Gallery-Aluminum! Better Be Minimum!

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This case report describes aluminum toxicity in a 62-year-old man with end-stage renal disease (ESRD) on hemodialysis who had chronic bilateral leg weakness, myalgias, swelling, and difficulty walking. He was found to have microcytic anemia and marked hypophosphatemia (phosphorus 1.0), which was unusual given his renal failure. The patient had been taking sucralfate since 2011 for severe esophagitis, and because sucralfate contains aluminum, long-term use in a patient with impaired renal clearance raised concern for aluminum toxicity.<br /><br />Despite repeated phosphorus supplementation, his levels remained low. Sucralfate was discontinued, and serum aluminum testing showed an elevated level of 19, supporting the diagnosis. His presentation was consistent with known manifestations of aluminum toxicity, including hypophosphatemia, muscle weakness, myalgias, and anemia.<br /><br />The report emphasizes that patients with ESRD are especially vulnerable to aluminum accumulation from medications such as sucralfate, antacids, some analgesics, antidiarrheals, and anti-ulcer agents. Diagnosis can be confirmed by bone biopsy showing aluminum deposition, or by elevated serum aluminum levels, sometimes after deferoxamine stimulation.<br /><br />The main takeaway is prevention: clinicians should be cautious when prescribing aluminum-containing medications to patients with kidney failure and should monitor for unexplained hypophosphatemia, weakness, or anemia.

Asset Subtitle

Aditi Bawa

Meta Tag

Author List Aditi Bawa, Anjana Chandrasekhara Pillai, Yusra Hassan

Category Clinical Vignettes

Concept Aluminum Toxicity

Concept Renal Failure

Concept Sucralfate

Concept Hypophosphatemia

Concept Osteomalacia

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Aditi Bawa

Track Adult

Keywords

aluminum toxicity

end-stage renal disease

hemodialysis

sucralfate

hypophosphatemia

microcytic anemia

muscle weakness

renal failure

aluminum accumulation

serum aluminum

Aluminum Toxicity

Renal Failure

Sucralfate

Hypophosphatemia

Osteomalacia