Wednesday, December 5, 2018

Acute Aluminum #Toxicity from Combination Therapy Sucralfate and Citric Acid in a #CardiacSurgery Patient by Andrea Sikora Newsome in BJSTR

Abstract

Background
#Sucralfate is used as #adjunctivetherapy in the management of #duodenalulcers [1]. Because sucralfate is an aluminum salt of sucrose sulfate, the typical dosing regimen of 1 gram every 6 hours provides approximately 828 mg of elemental aluminum (Al) daily; however less than 0.02% is systemically absorbed [3]. This intake contributes to the recommended daily intake of 0.12 mg aluminum/kg/day and #aluminumtoxicity has been previously reported as a known side effect of sucralfate administration [2]. Aluminum toxicity is defined as an aluminum #bloodconcentration greater than 60 ng/mL. Neurologic abnormalities, including #encephalopathy, confusion, and seizures, are the primary presenting symptoms [3]. Aluminum toxicity with sucralfate has been primarily described as a #chronictoxicity in patients with end stage renal disease (ESRD) due to multiple sources of aluminum combined with the inability to properly excrete aluminum [1]. Historically, ESRD patients faced high aluminum loads due to the use of aluminum containing phosphate binders in addition to the high concentrations of aluminum in the dialysate fluids. Additionally, some non-aluminum containing medications such as #ascorbicacid and #citricacid reduce Al3+ to Al2+, which leads to enhanced gastrointestinal tract absorption [4].

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