Textbook of Clinical Occupational and Environmental Medicine. Rosenstock L, Cullen MR, eds., Philadelphia, PA: W.B. Saunders Company, 1994 Jul; :729-732
Aluminum, one of the most plentiful naturally occurring metals on earth, does not occur unprocessed in its metallic state but in combination with other elements and compounds, including oxygen, fluorine, and silica. Bauxite, an are that contains variable quantities of alumina (aluminum oxide [AI,D,]), is the principal raw material from which metallic aluminum is produced. Aluminum production and use generally depend on three main steps: ( I) refining of bauxite to fied toxicologic experimentation, enhanced the ability of epidemiologists to assess exposure dose, and not surprisingly aids the clinician in evaluation as well. Almost all metals can be measured in some biologic fluid or system, although this does not always correlate either with external exposure dose or with toxicity. The available biologic tests of exposure are summarized in Table I and discussed with each of the metals in the sections that follow. Unfortunately, neither society's long acquaintance with these materials nor the more advanced level of our knowl· edge about their hazards mitigates the harsh reality that poisoning and other clinical effects of metals produce among the most prevalent and serious forms of occupational and environmental disease throughout the developed and developing world. The following sections review by agent the sources of exposure, mechanisms of disease, and established and suspected health effects. For each agent, details of treatment and strategies for prevention are emphasized. yield alumina; (2) electrolytic 'reduction of alumina to yield aluminum; and (3) aluminum casting into ingots for subsequent manufacturing uses.