Aluminum Toxicity and Death Following Intravesical Alum Irrigation in a Patient with Renal Impairment

Shoskes, Daniel A.; Radzinski, Charles; Struthers, N. W.; Honey, R. John D'a.

doi:10.1016/s0022-5347(17)37356-1

Cited by 26 publications

(12 citation statements)

References 6 publications

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“…This study found intravesical prostaglandin and continuous bladder irrigation with alum to be similarly effective in inducing remission of haematuria, although alum treatment had a higher incidence of relapse. There is a number of case reports reporting severe aluminium toxicity presenting as encephalopathy (Kanwar et al, 1996;Phelps et al, 1999;Nakamura et al, 2000), even leading to death (Seear et al, 1990;Shoskes et al, 1992). These events mostly occurred in the context of renal impairment, making alum salts a drug to be used with caution.…”

Section: Guideline ª 2008 the Authorsmentioning

confidence: 99%

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

et al. 2008

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SummaryHaemorrhagic cystitis (HC) is a common and, in its severe form, potentially life-threatening complication of Haematopoietic stem cell transplantation (HSCT) in children. Recent data indicate an important role of BK virus reactivation during the time of maximal post-transplant immune suppression in the pathogenesis of late-onset HC. Treatment of HC is mainly symptomatic and often frustrating. To give clinicians guidance on prevention and treatment options and their backing by scientific evidence, we have systematically assessed the available literature and devised evidence-based guidelines. Our comprehensive review demonstrates that evidence for the most commonly used interventions (such as cidofovir, oestrogen, hyperbaric oxygen, bladder instillation with formalin, alum salts or prostaglandin) is very limited. Some of these interventions also carry significant risks. Higher level evidence exists only for 2-mercaptoethane sodium (MESNA) and hyperhydration as a preventative intervention, and for systemic recombinant Factor VII as a treatment to stop acute haemorrhage. Further high-quality studies are required to establish effective and safe prevention and treatment options for HC.

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Section: Guideline ª 2008 the Authorsmentioning

confidence: 99%

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

et al. 2008

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Section: Discussionmentioning

confidence: 99%

“…Alum is an astringent and acts by protein precipitation over the bleeding surface ,,,. It leads to vasoconstriction and decreased capillary permeability, leading to reduced local oedema, inflammation and exudation ,,,. Disadvantages include high recurrence rates and the risk of aluminium toxicity with prolonged use which manifests as encephalopathy, dementia, speech disorders and seizures ,,,,,.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]5,6,[8][9][10][11][12] It leads to vasoconstriction and decreased capillary permeability, leading to reduced local oedema, inflammation and exudation. [1][2][3][4][5][6]8,10,11 Disadvantages include high recurrence rates and the risk of aluminium toxicity with prolonged use which manifests as encephalopathy, dementia, speech disorders and seizures. [1][2][3]5,6,8,10,11 Alum powder is inexpensive, but the labour requirements for pharmacy are intense due to dissolution issues, which in turn may cause time delays in treatment.…”

Section: Discussionmentioning

confidence: 99%

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Is there an alternative to alum for haemorrhagic cystitis? Intravesical alprostadil: our experience

Lee

Chan

2015

J Pharm Pract Res

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Background: The management of haemorrhagic cystitis is a therapeutic challenge. In this communication, we report the successful use of alprostadil as an intravesical dwell in controlling recurrent haematuria in a 66-year-old man with radiation cystitis. Clinical details: The patient had a long history of haematuria where continuous irrigation and alum was tried with minimal success. Silver nitrate or formalin were not considered as alternatives due to unfavourable side effects of crystallisation and sclerosis, respectively. Alprostadil was tried because the use of prostaglandin was supported by the literature and it was readily available. About 500 micrograms of alprostadil in 50 mL of 0.9% sodium chloride was given intravesically as a dwell for 60 min daily. The bladder was then drained and irrigation with 0.9% sodium chloride was continued to prevent further clotting. In all seven doses were given. Outcomes: Haematuria improved after the first dose. On Day 7, haematuria resolved and the patient was discharged from hospital. Conclusion: We found in our patient the use of prostaglandin E1 (alprostadil) was a relatively cost-effective, practical and safe option in controlling haematuria. It was relatively non-invasive and provided a rapid response to avoid severe blood loss.

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“…Our knowledge about intravesical use, first described by Ostroff and Chenault [4], is drawn from small case series conducted with 8 to 15 patients or from case reports. These reports include bladder bleeding in radiation cystitis, advanced bladder carcinoma, hemorrhagic cystitis, and post-transurethral resection of the prostate patients, as well as a patient in whom selective arterial embolization failed [4][5][6][7][8][9]. The median treatment time ranges from 3 to 4 days; however, it can be extended to 7 days.…”

Section: Intravesical Treatment Attemptsmentioning

confidence: 99%

Intractable Bladder Hemorrhage: Providing a Treatment Algorithm for a Complex Clinical Problem

Güven

Laguna

Kılınç

et al. 2011

Curr Bladder Dysfunct Rep

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Information about the frequency, intensity, prevention, treatment, and management of bladder hemorrhages, especially in patients with advanced bladder carcinoma, is lacking or scarce. The main treatment options are classified as intravesical treatment attempts using several chemical agents, placement of intrabladder compression balloon, hyperbaric oxygen treatment, transarterial embolization, or surgery. In view of the differences between patients with regard to the causes of bleeding, immediate treatment options, availability of the treatment modalities in each institution, life expectancy of the patient, and accompanying comorbidities, the management of each patient should be arranged individually. Nevertheless, based on the current literature, a treatment algorithm may be developed for these patients. The first step would be intravesical irrigation with substances with few side effects or intravesical balloon pressure treatment. If this treatment does not yield the expected result, hyperbaric oxygen therapy may be conducted in hemorrhagic cystitis or radiation cystitis patients; otherwise, transarterial embolization, the efficacy and safety of which are well-reported, should be performed. In these patients, application of surgical techniques and intravesical formalin are the last resorts.

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Aluminum Toxicity and Death Following Intravesical Alum Irrigation in a Patient with Renal Impairment

Cited by 26 publications

References 6 publications

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

Is there an alternative to alum for haemorrhagic cystitis? Intravesical alprostadil: our experience

Intractable Bladder Hemorrhage: Providing a Treatment Algorithm for a Complex Clinical Problem

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