Aluminum load in ICU patients during stress ulcer prophylaxis

Accumulating evidence has linked high aluminum (Al) levels with toxicity and disease. Our objective was to evaluate the Al exposure of ICU patients receiving stress ulcer prophylaxis with sucralfate and ranitidine.

Within a large prospective, randomized study, a subgroup of 30 critically ill, renally intact patients on prolonged mechanical ventilation who were being treated in intensive care units (ICU) of a university hospital were allocated to two prophylaxis subgroups: enteral sucralfate, 1 g six times daily by gastric tube (n=15), or intravenous ranitidine, 200 mg daily by 24-h continuous intravenous infusion (n=15). The Al content of large and small-volume parenterals was measured and Al intake calculated for each patient and day. Aluminum levels in serum and 24-h urine were monitored every 2 days during the 16-day observation period (days 0-15).

Mean daily parenteral Al exposure ranged from 101.3 to 158.7 mug/day for sucralfate and ranitidine patients, respectively. In both groups, Al serum levels increased from baseline on days 1-13 and on days 3-7 in the sucralfate and ranitidine groups, respectively. From days 3-13, Al serum levels were significantly higher with sucralfate than with ranitidine (P<0.05). On days 7-13, 24-h urinary Al excretion was also significantly higher in the sucralfate than in the ranitidine group (P<0.05).

In ICU patients, only approximately 50% of parenterally administered Al is eliminated renally. Sucralfate additionally increases patients exposure to Al. In ICU patients, the mean absorption of enteral Al from sucralfate is only 0.019%.