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2064329 
Technical Report 
Sucralfate-induced aluminum toxicity and deferoxamine treatment in a chronic renal failure patient 
Min, DI; Gunning, ME 
1991 
0 
ASHP Midyear Clinical Meeting Symposium Highlights
ISSN: 1557-0606 
IPA/92/990382 
VOL 26 ISS Dec 1991 
REF 
English 
IPA COPYRIGHT: ASHP Sucralfate is a basic aluminum salt of sucrose sulfate, which is widely used to treat peptic ulcer disease and gastritis. It provides a substantial aluminum load which can induce aluminum toxicity in end-stage renal failure patients. In our institution, we experienced one patient receiving chronic ambulatory peritoneal dialysis (CAPD) with worsening symptoms of aluminum toxicity while taking sucralfate. A 43-year-old white female with a 23-year history of insulin-dependent diabetes mellitus was brought to our hospital by her husband on July 9, 1990 due to mental status changes. Her past medical history included significant diabetes complications with end-stage renal failure, retinopathy and neuropathy and she received CAPD since June, 1987. Upon starting CAPD, she began to take 2 capsules of aluminum hydroxide (500 mg/capsule) t.i.d with meals for controlling her hyperphosphatemia or aluminum hydroxide gel (600 mg/5 ml) occasionally for her gastritis. During hospitalization, her serum aluminum level was 180 mcg (normal |LT/6 mcg/L, by flameless atomic absorption spectrometry). Because of her mental status and concern regarding her possible aluminum toxicity, all aluminum hydroxide products were replaced with calcium carbonate as a phosphate binder and sucralfate was started (1 gm four times daily) for her gastritis symptoms. Despite discontinuation of aluminum hydroxide products, she developed severe symptoms of aluminum toxicity such as mental confusion and dysarthria with very high serum aluminum levels (331 mcg/L) four months later. After sucralfate was stopped, she began to receive deferoxamine (DFO) 1 gm 3 times a week. Upon DFO therapy, her serum aluminum levels gradually decreased and her mental status was slowly improved. Sucralfate contains 20.69% of aluminum by weight and it should be avoided in end-stage renal failure patients due to the possible risk of aluminum toxicity.