Virtually all the aluminium hydroxide used commercially is manufactured by the Bayer process which involves dissolving bauxite in sodium hydroxide at temperatures up to . The waste solid, bauxite tailings, is removed and aluminium hydroxide is precipitated from the remaining solution of sodium aluminate. This aluminium hydroxide can be converted to aluminium oxide or alumina by calcination.
The residue or bauxite tailings, which is mostly iron oxide, is highly caustic due to residual sodium hydroxide. It was historically stored in lagoons; this led to the Ajka alumina plant accident in 2010 in Hungary, where a dam bursting led to the drowning of nine people. An additional 122 sought treatment for chemical burns. The mud contaminated  of land and reached the Danube. While the mud was considered non-toxic due to low levels of heavy metals, the associated slurry had a pH of 13.