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Plasma Aluminum Concentrations in Pediatric Patients Receiving Long-Term Parenteral Nutrition

Glenda Courtney-Martin1, Christina Kosar2, Alison Campbell3

  • 1Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada glenda.courtney-martin@sickkids.ca.

JPEN. Journal of Parenteral and Enteral Nutrition
|April 19, 2014
PubMed

Insights

Long-term parenteral nutrition (PN) in pediatric patients with intestinal failure (IF) in Canada leads to elevated aluminum (Al) levels, increasing toxicity risk. This highlights a critical need for Al content regulation in PN solutions.

Area of Science:

  • Clinical Nutrition
  • Toxicology
  • Pediatric Medicine

Background:

  • Long-term parenteral nutrition (PN) bypasses the gastrointestinal tract, increasing aluminum (Al) toxicity risk.
  • Al toxicity complications include metabolic bone disease and neurological impairment.
  • Canada lacks regulations on Al content in parenteral products, unlike the US.

Purpose of the Study:

  • To assess plasma Al concentrations in pediatric patients receiving long-term PN.
  • To determine Al intake from PN solutions in this patient cohort.
  • To evaluate the risk of Al toxicity in Canadian pediatric patients with intestinal failure (IF).

Main Methods:

  • Retrospective chart review of 27 pediatric patients with IF on long-term PN.
  • Comparison of plasma Al concentrations with age- and sex-matched controls.
  • Measurement of Al concentration in PN samples from 10 randomly selected patients to calculate Al intake.

Main Results:

  • Patients on long-term PN had significantly higher plasma Al concentrations than controls (1195 ± 710 vs 142 ± 63 nmol/L).
  • Mean Al intake from PN was 15.4 ± 15 µg/kg, three times the FDA recommended level.
  • Al intake was significantly correlated with plasma Al concentration (P = .02, r² = 0.52).

Conclusions:

  • Pediatric patients receiving long-term PN for IF in Canada face a significant risk of Al toxicity.
  • Elevated plasma Al levels indicate substantial Al absorption from PN solutions.
  • The findings underscore the need for Al content monitoring and regulation in PN for vulnerable pediatric populations.
Abstract

Keywords:
life cycleminerals/trace elementsnutritionparenteral nutritionpediatrics

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