Related Experiment Videos
Aluminum accumulation in critically ill children on sucralfate therapy
Kentigern Thorburn1, Mahil Samuel, Elisabeth Anne Smith
1Departments of Paediatric Intensive Care (Drs. Thorburn, Samuel, and Baines) and the Department of Biochemistry (Ms. Smith), Alder Hey Children's Hospital, Liverpool, UK.
Insights
Aluminum accumulates in critically ill children on sucralfate, particularly those with acute renal failure undergoing dialysis. Regular monitoring of serum aluminum is crucial for these patients.
Area of Science:
- Pediatric Intensive Care
- Nephrology
- Clinical Pharmacology
Background:
- Sucralfate is used for stress ulcer prophylaxis in critically ill patients.
- Sucralfate contains aluminum, which can be absorbed systemically.
- Potential for aluminum toxicity exists, especially in patients with impaired renal function.
Purpose of the Study:
- To investigate the development of toxic serum aluminum levels in critically ill children receiving short-term sucralfate therapy.
- To assess the correlation between sucralfate dosage and serum aluminum concentrations.
- To evaluate the impact of renal function, specifically dialysis, on aluminum accumulation.
Main Methods:
- Retrospective clinical study in a pediatric intensive care unit.
- Nineteen mechanically ventilated children received nasogastric sucralfate.
- Serum aluminum levels were measured after a median of 7 days of therapy.
- Comparison of aluminum levels between patients receiving and not receiving peritoneal dialysis.
- Serum creatinine levels were analyzed in relation to dialysis and aluminum levels.
Main Results:
- No correlation found between sucralfate dose (total or weight-adjusted) and serum aluminum levels.
- Significantly higher serum aluminum concentrations in patients receiving peritoneal dialysis (median 2.86 µmol/L) compared to those not dialyzed (median 0.55 µmol/L) (p=0.001).
- Dialyzed patients had higher peak serum creatinine levels (median 500 µmol/L) than non-dialyzed patients (median 98 µmol/L) (p=0.006).
- A trend towards correlation between peak serum creatinine and serum aluminum was observed (p=0.06).
Conclusions:
- Aluminum accumulation occurs in critically ill children with acute renal failure treated with sucralfate.
- Patients undergoing dialysis are particularly susceptible to higher serum aluminum levels.
- Regular monitoring of serum aluminum concentrations is recommended when using sucralfate in children with renal failure.
Abstract:
BACKGROUND: Sucralfate, used in stress ulcer prophylaxis, contains aluminum, which can be absorbed from the gut. OBJECTIVE: To determine whether toxic serum aluminum levels can develop after short-term sucralfate therapy in critically ill children. DESIGN: Retrospective clinical study. SETTING: Pediatric intensive care unit of a pediatric university hospital. PATIENTS: Nineteen patients receiving mechanical ventilatory support (median age, 5 yrs [range, 0.25-16 yrs]; median weight, 17 kg [range, 3.5-60 kg]). INTERVENTIONS: All patients received sucralfate suspension nasogastrically. Measurements and RESULTS: Serum aluminum concentrations were measured after a short period on sucralfate therapy (median time, 7 days [range, 3-14 days]). There was no correlation between total sucralfate dose received (p =.35) or dose of sucralfate per unit of body weight (p =.55) and serum aluminum. Nine patients received peritoneal dialysis. Serum aluminum levels were higher in the nine patients who received peritoneal dialysis (median aluminum concentration, 2.86 &mgr;mol/L [range, 0.19-12.3 &mgr;mol/L]) than the ten patients not dialyzed (median aluminum concentration, 0.55 &mgr;mol/L [range, 0.18-0.94 &mgr;mol/L]) (p =.001). The peak serum creatinine levels were higher in the dialyzed patients (median creatinine level, 500 &mgr;mol/L [range, 163-910 &mgr;mol/L]) than those not dialyzed (median creatinine level, 98 &mgr;mol/L [range, 36-415 &mgr;mol/L]) (p =.006). There was a trend toward correlation between peak serum creatinine and serum aluminum (p =.06). CONCLUSION: Aluminum accumulation occurs in children with acute renal failure on sucralfate, especially those receiving dialysis. If sucralfate is used in children in renal failure, serum aluminum concentrations should be monitored regularly.