Water contaminants associated with clinical manifestations of intoxication^[1]

Symptom	Possible contaminant involved
Abdominal pain	Lead
Anemia	Aluminum, copper, chloramine, zinc
Bone disease	Aluminum, fluoride
Cardiac arrest	Fluoride (acute exposure to high concentrations), sodium hypochlorite
Chest pain	Fluoride
Chills	Copper, endotoxin
Cognitive changes	Aluminum, lead
Cyanosis	Hydrogen peroxide, silver-stabilized peroxide
Death	Aluminum, bacteria, chloramine, endotoxin, fluoride, microcystins
Encephalopathy	Aluminum
Fever	Bacteria, endotoxin
Hemolysis	Chloramine, copper, nitrates, sodium hypochlorite, peracetic acid
Hypertension	Calcium, sodium
Hypotension	Bacteria, endotoxin, nitrate, chlorine, monochloramine
Hyperkalemia	Sodium hypochlorite
Metabolic acidosis	Low pH, sulfate
Methemoglobinemia	Chloramine, nitrates, hydrogen peroxide, silver-stabilized peroxide
Muscle weakness	Calcium, lead, magnesium
Nausea and vomiting	Bacteria, calcium, copper, endotoxins, fluoride, low pH, magnesium, nitrates, sulfate, zinc, chlorine, monochloramine
Neurologic changes	Aluminum
Peripheral neuropathy	Lead
Pruritus	Fluoride
Visual disturbances	Microcystins
Liver failure	Microcystins

Reference:

Layman-Amato R, Curtis J, Payne GM. Water treatment for hemodialysis: An update. Nephrol Nurs J 2013; 40:384.

Adapted from: ACI-NSW Renal Services Network 2018: Water for dialysis: A guide for in-centre, satellite and home haemodialysis in NSW. Available at: https://www.aci.health.nsw.gov.au/networks/renal (Accessed on August 27, 2020).

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Water contaminants associated with clinical manifestations of intoxication[1]

Water contaminants associated with clinical manifestations of intoxication^[1]