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[Aluminum contamination of pediatric parenteral nutrition solutions]
M D Aumente Rubio1, M D Panadero Ruz, M T Francisco Barrero
1Servicio de Farmacia, Hospital Universitario Reina Sofía, Córdoba, España.
Insights
Aluminum toxicity in premature newborns receiving IV therapy is a significant risk due to parenteral exposure and impaired kidney function. Calcium and phosphorus salts in IV solutions are highly contaminated with aluminum, necessitating manufacturing controls.
Area of Science:
- Clinical Chemistry
- Pediatric Medicine
- Toxicology
Background:
- Aluminum toxicity presents with severe clinical manifestations including encephalopathy, osteomalacia, anemia, and cholestasis.
- Premature newborns are particularly vulnerable to aluminum intoxication due to parenteral exposure and immature kidney function.
- Parenteral nutrition is a common therapy for premature infants, increasing their risk of aluminum exposure.
Purpose of the Study:
- To quantify aluminum contamination in intravenous (IV) solutions used for pediatric parenteral nutrition.
- To identify the most contaminated components within these IV solutions.
- To assess the implications of aluminum contamination for at-risk infant populations.
Main Methods:
- Atomic absorption spectrophotometry was employed to measure aluminum levels.
- Analysis included individual IV solution components and prepared parenteral nutrition units.
- Quantification of aluminum contaminant levels in various salt and trace element solutions.
Main Results:
- Calcium salts (5.18 +/- 2.88 ppm) and phosphorus salts (3.96 +/- 3.52 ppm) were identified as the most significantly contaminated components.
- Trace elements also showed aluminum contamination (1.52 +/- 0.92 ppm).
- Observed aluminum levels align with findings of bone and liver accumulation in previous studies.
Conclusions:
- Significant aluminum contamination exists in IV solutions used for pediatric parenteral nutrition.
- Variability in contamination across manufacturers and batches suggests contamination occurs during the manufacturing process.
- Implementing stringent manufacturing controls could prevent aluminum overdose in vulnerable infant populations.
Abstract:
The main clinical manifestations of aluminum toxicity include progressive encephalopathy, osteomalacia, microcytic hypochromic anemia, and cholestasis. The premature newborn receiving IV therapy are at high risk of such aluminium intoxication: two conditions predispose them to an aluminum overdose-parenteral exposure and their reduced kidney function. The amount of aluminum present as contaminant was calculated for each of the i.v. solutions used in the preparation of the parenteral nutrition units in pediatrics, along with that for three prepared nutritions. This was done using atomic absorption spectrophotometry. The calcium salts (5.18 +/- 2.88(5)ppm), phosphorus salts (3.96 +/- 3.52(5)ppm) and trace elements (1.52 +/- 0.92(4) ppm) were the most contaminated components, the amount of aluminum being similar to that found by other authors showing bone and liver accumulations. The great variability between the solutions of different manufacturers and of different batches suggests that the contamination takes place during manufacture, so that it could in many cases be prevented by establishing adequate controls.