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Dangerous Waters

Samuel Vaisrub, MD
JAMA. 1978;240(15):1630. doi:10.1001/jama.1978.03290150076033.
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No less perilous than stormy seas are the waters that reach our "sea within" by the oral or parenteral route. Some hazards, such as contamination by bacteria, are well known and are often guarded against. Others, such as excess or deficiency of some solute, are still in the realm of investigation. Still others are in gray zones of suspicion and conjecture.

Emerging from the area of conjecture into that of investigation and near-certainty is a relatively recent danger that lurks in the water of dialysis. Impressive evidence has accumulated to incriminate aluminum in the causation of dialysis encephalopathy with dementia (dialysis dementia, dementia dialytica) as the striking manifestation.

In the early days of hemodialysis, Peterson and Swanson1 described three cases of encephalopathy precipitated by this therapy. They ascribed the encephalopathy to acute water intoxication caused by rapid removal of extracellular urea. In 1972 Alfrey et al2 reported on


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