Aluminum intoxication in dialysis patients.
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Biomedical subjects
Publications and source records attributed to O Wawschinek.
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Wilson's disease, a hereditary disorder of copper metabolism, is characterized by excessive storage of this metal in several organs. Storage of copper in liver tissue is of great importance in diagnosis and therapy. By means of the combination of two methods - low-temperature ashing and flameless atomic absorption - the copper determination can be made even in smallest liver samples (needle-biopsy samples). It is therefore possible to perform a histological examination, as well as a quantitative copper determination on one puncture sample.
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64 patient on chronic haemodialysis were investigated. The duration of the dialysis was 44 months; the mean age of patients was 41 years. In 6 patients a diagnosis of Dementia was made in addition to apraxia, dysarthria and anarthria. 5 of the patients died. All the demented patients showed an abnormal EEG and 4 had atrophy in the computertomogram. The plasma aluminium levels were significantly raised (409 microgram/l) in the demented group as compared to the non-demented dialysis patients (189 microgram/l).
18 data with etiopathogenetic relations to the dialysis encephalopathy, such as plasma aluminum levels, parameters of azotemia and parathyroid function, blood pressure, IQ, and EEG-findings, were compared between 5 patients suffering with encephalopathy and 54 dialysis-patients without neurological symptoms. The investigations, including statistical computations (variance analysis, multiple linear regression, multivariate analysis) elicited the following results: 1. All patients suffering from encephalopathy showed higher plasma aluminum concentrations (505 +/- 58 microgram/L : 228.9 +/- 213 microgram/L, p = greater than 0.01), higher serum calcium levels (2.48 +/- 0.15 mmol/L : 2.35 +/- 0.11 mmol/L, p = less than 0.001), higher rates of osteopathy and abnormal EEG's (5 of 5 : 7 in 41 patients). 2. Age, duration of dialysis treatment, quality of dialysis treatment, blood pressure, did not show any pathogenetic influence. 3. Hyperaluminemia was caused by the oral administration of aluminum hydroxide. After reduction of the daily dose from originally 6.18 +/- 3.24 gm to 1.52 +/- 0.45 gm, the plasma aluminum levels decreased to 54.05 +/- 34.59 microgram/L without any adverse effects on the serum phosphate levels. The results suggest that dialysis-patients need less AI-OH than is usually indicated. 4. Encephalopathy did not occur after normalisation of plasma aluminum levels. 5. With respect to the aluminum toxicity in dialysis-patients, dialysis encephalopathy should not be classified as a complication of multifactorial etiology. Only hyperparathyroidism seems to be an additional risk factor.
In a case of severe poisoning with the organophosphorous insecticide methidathione standardized forced diuresis and peritoneal dialysis were performed for the first time in addition to the usual therapeutical procedures (e.g. repeated gastric lavage, induced diarrhea, atropine and intensive care). The course of the illness as well as the duration of the acute phase were significantly shorter than in comparable cases. No hazardous situation occurred after the first hours of treatment. The presence of the organophosphorous cholinesterase inhibitor or of its metabolites in the urine and the dialysate was proved by thin-layer chromatography.
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