Patient selection: severe hemorrhagic cystitis
A 1% solution of alum is used for continuous irrigation of the bladder through a 3-way Foley catheter.
Blood aluminum levels can be monitored by direct assay (not readily available) or by monitoring prothrombin time (increases as aluminum levels, up to 1.5 times normal control).
Aluminum intoxication can cause an encephalopathy with mental status changes, disturbed speech and tremor.
Risk factors for aluminum toxicity:
(1) acute or chronic renal failure
(2) high aluminum exposure (concurrent aluminum-containing antacids, prolonged irrigation, etc)
(3) failure to monitor for early neurological signs of aluminum toxicity
Conditions associated with poor hemorrhage control during alum infusion:
(1) thrombocytopenia
(2) other hypocoagulable state
(3) large vessel hemorrhage
