During the last 15 years, accumulating evidence has implicated aluminum in disorders associated with chronic renal failure.1-6 The well-recognized manifestations of systemic aluminum toxicity include fracturing osteomalacia, dialysis encephalopathy, and microcytic hypochromic anemia. More recently, aluminum loading has been demonstrated in premature infants receiving intravenous fluid therapy.7 Although the clinical importance of this finding is unclear, it warrants careful attention. The association between aluminum excess and neurologic dysfunction, which has been reported in patients with chronic renal failure, suggests the possibility that aluminum overload may contribute to the pathogenesis of CNS damage in the sick premature infant.7,8
Aluminum, which is the most abundant metal in the earth's crust, is ubiquitous in its distribution.7 There is constant exposure to this element through ingestion of water and food and exposure to dust particles.10 Because aluminum sulfate (alum) is used as a flocculating agent in the purification of municipal water supplies, drinking water may contain high levels of aluminum (up to 1,000 µg/L). Aluminum cans, containers, and cooking utensils, as well as aluminum-containing medications, are also potential sources of oral intake of aluminum. Increase in aluminum intake as a result of transfer through the skin is probably negligible; however, exposure is common due to use of aluminum in deodorants.10 Some inhaled aluminum is retained in pulmonary tissue and in the peribronchial lymph nodes, but it is largely excluded from other tissues. Pulmonary aluminum concentration increases with age; unlike aluminum levels in other tissues, the concentration in the lung does not correlate with that in other tissues.