A case report of a 79-year-old female with aluminum toxicity presenting with altered mental status in Eldoret, Kenya

Abstract

Introduction

Aluminum is renally excreted and can cause toxicity in patients with end-stage renal disease (ESRD). In low- and middle-income countries (LMICs), potential sources of aluminum toxicity include the use of aluminum cookware and clay pots, well water, and contaminated dialysis water.

Patient concerns

We report a case of an elderly East African woman from a rural area with ESRD who was undergoing twice-weekly hemodialysis and who presented with altered mental status. Acute cardiac and neurological events were ruled out. A head CT scan was normal. Both the infectious and metabolic workups were unremarkable. Since the patient came from a rural home where her family used clay pots, aluminum utensils, and well water for drinking, a decision was made to rule out aluminum toxicity. Serum aluminum levels were significantly elevated at 534 micrograms/L.

Diagnosis

Aluminum toxicity based on the clinical presentation and elevated serum aluminum levels

Interventions

Daily hemodialysis with a high-flux dialyzer. Deferoxamine was not administered because of concerns about life-threatening neurotoxicity.

Outcomes

Her mental status started to improve within a week of initiating intensified hemodialysis. After nine months, her serum aluminum level decreased by more than 50 %, and the patient’s cognition returned to her baseline.

Take-home lessons

ESRD patients in LMICs are at greater risk for potential aluminum toxicity than are those in developed countries. Regular testing of serum aluminum levels is necessary in these patients since the initial presentation of aluminum toxicity can be nonspecific.