Some patients are showing elavated aluminum levels in blood work...any ideas?? Already checked the RO water feeding the machines.

You didn't say if you had a central acid system or not, but there have been cases of elevated aluminum due to acid concentrate coming into contact with aluminum...aluminum wrench dropped into acid tank, acid pump/drum pump with aluminum parts, stainless-steel-looking part that is actually aluminum. In this case, if you have patients who use jugs of acid, they would tend not to have aluminum contamination.

Make sure that there is not something in the bottom of your holding tank (ie. a tool like a crescent wrench like florian said). I have actually seen this before, the easiest way to rule out the loop and holding tank is to do an AAMI on your loop return.

Since it is only some pts., consider it may be the pts. Could possibly be dietary, binders, meds, utensils, pots and pans, etc. Just a thought from my clinical days.

This happened at a clinic that I worked at. I don't know what kind of concentrate regulator that you have on the wall box, but the one that I had had a metal spring on the inside that leached into the concentrate. Turned out that we had a mixture of regulators some with this spring and some without. With the spring pts. had elevated aluminum. These regulators were black and available through Better Water. I' sorry, but I forget the name. It was a few years ago. Either way check the wall pressure regulators if you have them. Hope this helps.

check the aluminum levels on the output of your ro this time of year the city ups the alum

Check your water at the return, on the off chance that there could be something aluminum in your loop. I would check the dialysate too.

I know of a case where an RO membrane became fouled with aluminum. The water analysis and dialysate analysis showed OK aluminum levels, but the patients all had elevated blood levels.

Very serious.

Dealer brings up a good point. If the aluminum is in the water, sometimes it is difficult for the RO to remove it. I know of a clinic who had an RO running at 98% rejection, but the aluminum did not meet AAMI. If the aluminum gets by the RO, a mixed bed DI may have limited ability to remove it. In this case, a Cation DI tank followed by an Anion DI Tank, followed by a mixed bed DI Tank would work better. You need the Cation DI Tank to reduce the pH to allow the aluminum to be removed.

Thanks for all the input....the comment about the regulator springs caught my interest..I have tried all the logical things spoken here so far.

Have you tried sending in a dialysate sample for testing. I know the lab we use Nationwide can and do run tests on our dialysate for cemical annalysis. I am sure if you send your bicarbs off for sampling, that lab can run tests to see if there is aluminum in your dialysate. I would sample mostly the machines the pt's sit at and one that you know you don't have any problems and compair.