Dialysis encephalopathy and fracturing osteomalacia, which occur in hemodialysis units that use dialysis fluid contaminated with aluminum, have largely disappeared. This has been accomplished by establishing standards for safe concentrations of aluminum in dialysates. Infants, children, and adults with chronic renal failure who are not receiving dialysis have been shown to be at risk for aluminum intoxication from the oral administration of aluminum-containing phosphate binders. This complication should be avoided with the use of phosphate binders that do not contain aluminum and the use of other measures to control hyperphosphatemia.

A number of substances commonly administered intravenously, including calcium and phosphorus salts and albumin, have high levels of aluminum. Premature infants receiving intravenous fluid therapy may accumulate aluminum and show evidence of aluminum toxicity. Efforts are being made to reduce the levels of aluminum in products added to intravenous solutions; these efforts must continue.

Some infant formulas may contain relatively high concentrations of aluminum. The reported concentrations of aluminum in soy formulas and premature infant formulas are higher than those in other infant formulas. The potential impact of these formulas on the aluminum intake of premature infants and infants with impaired renal function should be recognized, although it is not clear that toxic effects result from the use of the formulas in these situations.

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