It would be valuable to define as completely as possible which patient groups are at risk for iatrogenic aluminum loading, and under which conditions aluminum represents a health hazard. The more complete knowledge we have for the clinical, iatrogenic setting, the better basis we will have to judge whether different types of aluminum exposure are hazardous to the general population or to susceptible subgroups. A provisional list of patients groups at risk of iatrogenic aluminum loading should include, at least, people with impaired renal function, infants, old people and patients on total home parenteral nutrition. However, further studies are necessary. Al may enter human body by mouth, intravenous infusions and by environment.
Specific controls have to be adopted in order to reduce each risk of exposure.
Silicon is relevant to aluminum toxicity and, therefore, the water silicon concentrations should be monitored in parallel. The aluminum content should be declared in all food preparations and pharmacological products. Citrate-containing compounds appear to increase the bioavailability of ingested aluminum. Therefore, particular care should be taken to avoid these compounds in combination with Al-containing drugs. With citric acid, the enhanced gastrointestinal absorption may by compensated for by a parallel increase in urinary Al excretion, where there is good renal function.