Aluminum in parenteral solutions revisited--again

It has been a dozen years since aluminum was first shown to contaminate parenteral nutrition solutions and to be a contributing factor in the pathogenesis of metabolic bone disease in parenteral nutrition patients as well as in uremic patients. However, there are no regulations in place to effectively reduce aluminum contamination of various parenterally administered nutrients, drugs, and biologic products. The purpose of this review is fourfold: 1) to summarize our knowledge of the adverse effects of aluminum on bone formation and mineralization in parenteral nutrition patients; 2) to discuss the possible role of aluminum in the osteopenic bone disease of preterm infants; 3) to show how lack of regulations covering aluminum content of parenteral solutions can lead to vulnerability of new groups of patients to aluminum toxicity, the example being given here is that of burn patients; and 4) to trace the development of efforts at regulating the aluminum contamination of large- and small-volume parenteral drug products and to point out what still needs to be done in this regard.