Acute aluminum toxicity and alum bladder irrigation in patients with renal failure

Intravesical alum instillation is an increasingly common treatment for hemorrhagic cystitis. It has been claimed that this therapy is safe in patients with renal failure. We report the case of a patient with renal failure following a bone marrow transplantation who developed an acute encephalopathy from apparent aluminum intoxication following intravesical alum. In a review of the literature, we have found two similar cases of acute aluminum intoxication from alum in patients with renal failure who have received multiagent chemotherapy. We suggest that alternate therapies be selected for hemorrhagic cystitis in such patients.