Abstract
Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN solution products prior to being compounded in the clinical setting [1]. The investigation assessed quantitative Al content of all available products used in the formulation of PN solutions. The objective of this study was to assess the Al exposure in neonatal patients using the least contaminated PN solutions and determine if it is possible to meet the FDA “safe limit” of less than 5 μg/kg/day of Al. The measured concentrations from our previous study were analyzed and the least contaminated products were identified. These concentrations were entered into our PN software and the least possible Al exposure was determined. A significant decrease (41%–44%) in the Al exposure in neonatal patients can be achieved using the least contaminated products, but the FDA “safe limit” of less than 5 μg/kg/day of Al was not met. However, minimizing the Al exposure may decrease the likelihood of developing Al toxicity from PN.
Highlights
Aluminum is the most abundant metallic element on Earth and is naturally occurring in certain minerals, ores, oxides, and silicates
Aluminum toxicity has been documented in the medical literature for over 30 years [2,3,4,5,6,7,8,9]
Patients at greatest risk for aluminum toxicity from Parenteral nutrition (PN) include those with underlying renal dysfunction and prolonged courses of PN therapy
Summary
Aluminum is the most abundant metallic element on Earth and is naturally occurring in certain minerals, ores, oxides, and silicates. Renal excretion removes 99% of the aluminum that enters the blood stream [2]. Despite these protective mechanisms, aluminum toxicity has been documented in the medical literature for over 30 years [2,3,4,5,6,7,8,9]. Patients at greatest risk for aluminum toxicity from PN include those with underlying renal dysfunction and prolonged courses of PN therapy. Premature infants are at high risk of aluminum accumulation and toxicity as they often require PN for many days and have immature kidneys incapable of excreting aluminum efficiently. Calcium gluconate and phosphate salts are known to be especially high in aluminum content and are often administered to premature infants in substantial amounts to promote bone mineralization [10,13,14]
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