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EC number: 233-135-0 | CAS number: 10043-01-3
- Life Cycle description
- Uses advised against
- Endpoint summary
- Appearance / physical state / colour
- Melting point / freezing point
- Boiling point
- Density
- Particle size distribution (Granulometry)
- Vapour pressure
- Partition coefficient
- Water solubility
- Solubility in organic solvents / fat solubility
- Surface tension
- Flash point
- Auto flammability
- Flammability
- Explosiveness
- Oxidising properties
- Oxidation reduction potential
- Stability in organic solvents and identity of relevant degradation products
- Storage stability and reactivity towards container material
- Stability: thermal, sunlight, metals
- pH
- Dissociation constant
- Viscosity
- Additional physico-chemical information
- Additional physico-chemical properties of nanomaterials
- Nanomaterial agglomeration / aggregation
- Nanomaterial crystalline phase
- Nanomaterial crystallite and grain size
- Nanomaterial aspect ratio / shape
- Nanomaterial specific surface area
- Nanomaterial Zeta potential
- Nanomaterial surface chemistry
- Nanomaterial dustiness
- Nanomaterial porosity
- Nanomaterial pour density
- Nanomaterial photocatalytic activity
- Nanomaterial radical formation potential
- Nanomaterial catalytic activity
- Endpoint summary
- Stability
- Biodegradation
- Bioaccumulation
- Transport and distribution
- Environmental data
- Additional information on environmental fate and behaviour
- Ecotoxicological Summary
- Aquatic toxicity
- Endpoint summary
- Short-term toxicity to fish
- Long-term toxicity to fish
- Short-term toxicity to aquatic invertebrates
- Long-term toxicity to aquatic invertebrates
- Toxicity to aquatic algae and cyanobacteria
- Toxicity to aquatic plants other than algae
- Toxicity to microorganisms
- Endocrine disrupter testing in aquatic vertebrates – in vivo
- Toxicity to other aquatic organisms
- Sediment toxicity
- Terrestrial toxicity
- Biological effects monitoring
- Biotransformation and kinetics
- Additional ecotoxological information
- Toxicological Summary
- Toxicokinetics, metabolism and distribution
- Acute Toxicity
- Irritation / corrosion
- Sensitisation
- Repeated dose toxicity
- Genetic toxicity
- Carcinogenicity
- Toxicity to reproduction
- Specific investigations
- Exposure related observations in humans
- Toxic effects on livestock and pets
- Additional toxicological data
Direct observations: clinical cases, poisoning incidents and other
Administrative data
- Endpoint:
- direct observations: clinical cases, poisoning incidents and other
- Type of information:
- migrated information: read-across based on grouping of substances (category approach)
- Adequacy of study:
- key study
- Reliability:
- 2 (reliable with restrictions)
- Rationale for reliability incl. deficiencies:
- other: Reliable with restrictions.
Data source
Reference
- Reference Type:
- study report
- Title:
- Unnamed
- Year:
- 1 998
Materials and methods
- Study type:
- clinical case study
- Endpoint addressed:
- repeated dose toxicity: oral
- immunotoxicity
Test guideline
- Qualifier:
- according to guideline
- Guideline:
- other: osteomalacia due to antacid use associated with stainable bone aluminum in a patient with normal renal function.
- Principles of method if other than guideline:
- The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Treatment included withdrawing the antacid and supplementation with phosphate, calcium, and vitamin D.
- GLP compliance:
- not specified
Test material
- Reference substance name:
- Aluminium hydroxide
- EC Number:
- 244-492-7
- EC Name:
- Aluminium hydroxide
- Cas Number:
- 21645-51-2
- IUPAC Name:
- aluminum trihydroxide
- Test material form:
- solid: compact
- Details on test material:
- - Name of test material :aluminium hydroxide
- Molecular formula :Al(OH)3,
- Molecular weight :78.00 g/mol
- Smiles notation :[Al+3].[OH-].[OH-].[OH-]
- InChl :1/Al.3H2O/h;3*1H2/q+3;;;/p-3
- Structural formula attached as image file : see Fig.1
- Substance type: inorganic
- Physical state: White amorphous powder
- Density :2.42 g/cm³, solid
- Melting point: 300 °C, 573 K, 572 °F
- Solubility in water: 0.0001 g/100 mL (20 °C)
-Solubility: soluble in acids, alkalis, HCl, H2SO4
-Acidity (pKa) >7
-Flash point: Non-flammable
Constituent 1
Method
- Type of population:
- other: A case of osteomalacia subsequent to chronic antacid use in a patient with normal renal function
- Subjects:
- The 39 year old female patient consumed approximately 70g of a commercial antacid daily for approximately 8 years, which is equivalent to consumption of over 18 kg of elemental aluminium. The daily dose ingested by this individual exceeded the manufacturer=s recommended maximum daily dose for this antacid. The patient developed severe osteomalacia due to phosphate depletion.
- Ethical approval:
- confirmed, but no further information available
- Route of exposure:
- oral
- Reason of exposure:
- intentional, occupational
- Exposure assessment:
- measured
- Details on exposure:
- The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Bone biopsy revealed stainable aluminum deposits along 27.6% of the total bone surface, which is a unique observation in a patient with normal renal function
- Examinations:
- This report concerns the case of a 39-year-old pharmacist who self-mediated for peptic ulcer disease with high doses of a potent antacid containing aluminum and magnesium hydroxide. The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Bone biopsy revealed stainable aluminum deposits along 27.6% of the total bone surface, which is a unique observation in a patient with normal renal function.
- Medical treatment:
- Treatment included withdrawing the antacid and supplementation with phosphate, calcium, and vitamin D. She experienced marked subjective and objective improvement with this regimen. This included a striking increase in her bone mineral density occurring over the 2-year follow-up period.
Results and discussion
- Clinical signs:
- The 39 year old female patient consumed approximately 70g of a commercial antacid daily for approximately 8 years, which is equivalent to consumption of over 18 kg of elemental aluminium. The patient developed severe osteomalacia due to phosphate depletion.
- Results of examinations:
- This case documents that long-term antacid therapy, even when used by patients with normal renal function and within the manufacturer's label recommendations, can lead to severe phosphate depletion, osteomalacia, and toxic accumulation of aluminum and magnesium.
- Effectivity of medical treatment:
- The clinical syndrome was readily treated by withdrawal of the antacid and with calcium and phosphate supplementation. Physicians recommending treatment with these compounds or learning of their patient's self-medication with them should inform the patient of the potential serious side effects these agents can cause when used chronically at maximally recommended doses.
- Outcome of incidence:
- The patient condition improved after cessation of antacid use and supplementation with calcium, phosphate and vitamin D.
Applicant's summary and conclusion
- Conclusions:
- This case documents that long-term antacid therapy, even when used by patients with normal renal function and within the manufacturer's label recommendations, can lead to severe phosphate depletion, osteomalacia, and toxic accumulation of aluminum and magnesium. This clinical syndrome was readily treated by withdrawal of the antacid and with calcium and phosphate supplementation. Physicians recommending treatment with these compounds or learning of their patient's self-medication with them should inform the patient of the potential serious side effects these agents can cause when used chronically at maximally recommended doses.
- Executive summary:
Antacids containing aluminum and magnesium hydroxide are widely used nonprescription agents for treatment of gastritis and peptic ulcer disease. One of the side effects of these antacids is that they bind phosphate in the gut, resulting in its malabsorption. Short-term use, consistent with the directions on the manufacturer's label, is safe and effective for most patients. Heavy chronic use, even when within label, can cause serious skeletal impairment. This report concerns the case of a 39-year-old pharmacist who self-mediated for peptic ulcer disease with high doses of a potent antacid containing aluminum and magnesium hydroxide. The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Bone biopsy revealed stainable aluminum deposits along 27.6% of the total bone surface, which is a unique observation in a patient with normal renal function. Treatment included withdrawing the antacid and supplementation with phosphate, calcium, and vitamin D. She experienced marked subjective and objective improvement with this regimen. This included a striking increase in her bone mineral density occurring over the 2-year follow-up period.
This case documents that long-term antacid therapy, even when used by patients with normal renal function and within the manufacturer's label recommendations, can lead to severe phosphate depletion, osteomalacia, and toxic accumulation of aluminum and magnesium. This clinical syndrome was readily treated by withdrawal of the antacid and with calcium and phosphate supplementation. Physicians recommending treatment with these compounds or learning of their patient's self-medication with them should inform the patient of the potential serious side effects these agents can cause when used chronically at maximally recommended doses.
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