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Schönenberger KA, Saxer C, Neyer PJ, Huwiler VV, Reber E, Hammerer-Lercher A, Stanga Z, Mühlebach S. Aluminum and other chemical elements in parenteral nutrition components and all-in-one admixtures. Clin Nutr 2023; 42:2475-2483. [PMID: 38411019 DOI: 10.1016/j.clnu.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND & AIMS Parenteral nutrition (PN) can lead to high or even toxic exposure to aluminum (Al). We aimed to quantify concentrations of Al and other chemical elements of all-in-one (AIO) PN admixtures for adults prepared from commercial multichamber bags (Olimel® 5.7%, Omegaflex® special, SmofKabiven®, all with and without electrolytes) and vitamin and trace element additives over a 48-h period. Secondly, we determined the level of Al contamination resulting from admixing and infusion set use. METHODS We used dynamic reaction cell and kinetic energy discrimination inductively coupled plasma mass spectrometry (ICP-MS) to quantify Al, arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), tin (Sn), vanadium (V), and zinc (Zn) in AIO PN admixtures. We extracted samples for analysis via the bag injection ports and infusion sets over a 48-h period after admixing. We compared the measured Al concentrations of AIO PN admixtures with calculated values based on the measured concentrations of individual chamber contents and additives. RESULTS Mean (standard deviation) baseline Al concentrations in AIO PN admixtures ranged from 10.5 (0.5) to 59.3 (11.4) μg/L and decreased slightly over the 48 h (estimate [standard error] -0.09 [0.02] μg/L/hour, p <0.001). Thus, certain products exceeded the widely accepted limit of 25 μg/L. There was no significant difference in Al concentrations between samples extracted via the bag injection ports or infusion sets (p = 0.33), nor between measured and calculated Al concentrations of AIO PN admixtures (p = 0.91). CONCLUSION Because certain commercially available PN admixtures for adults proved to contain excessively high levels of Al in our study, regulations and corresponding quality requirements at the authority level (e.g., Pharmacopoeia and regulatory authorities) are urgently required. Our results showed that the PN handling process (admixing and supplementing additives) or the materials of the infusion set did not lead to additional Al contamination to any extent. Moreover, calculated Al concentrations of AIO PN admixtures derived from individual chamber contents and additives are valid.
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Affiliation(s)
- Katja A Schönenberger
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
| | - Christoph Saxer
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Peter J Neyer
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Valentina V Huwiler
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | | | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland
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Romanowska H, Bartoszewicz K, Danko M, Wielopolska J, Popińska K, Żydak J, Sibilska M, Borkowska A, Szlagatys-Sidorkiewicz A, Książyk J. Unexpected Serum and Urine Aluminum Concentrations in Pediatric Patients on Home Parenteral Nutrition. Nutrients 2023; 15:3597. [PMID: 37630787 PMCID: PMC10458977 DOI: 10.3390/nu15163597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
The intravenous supply of aluminum (Al) present in parenteral nutrition solutions poses a high risk of the absorption of this element, which can result in metabolic bone disease, anemia, and neurological complications. The aim of this study is to determine the impact of long-term parenteral nutrition (PN) in children on serum Al concentration and its urinary excretion compared to healthy children. We evaluated serum Al concentrations and its urinary excretion in patients enrolled in the Polish home parenteral nutrition (HPN) program between 2004 and 2022. The study group included 83 patients and the control group consisted of 121 healthy children. In children whose PN was started in the neonatal period, we found higher serum Al concentrations and higher urinary Al excretion than in other subjects whose PN was started later. Only 12% of the children on chronic parenteral nutrition had serum Al concentrations of less than 5 μg/L. Healthy children in the control group had higher serum Al concentrations than those in the parenteral nutrition group, which may indicate the influence of one's environment and diet on Al serum levels.
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Affiliation(s)
- Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Klaudia Bartoszewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Mikołaj Danko
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Wielopolska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Katarzyna Popińska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Żydak
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Marta Sibilska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Anna Borkowska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
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Mihatsch W, Fewtrell M, Goulet O, Molgaard C, Picaud JC, Senterre T, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, Darmaun D, Decsi T, Domellöf M, Embleton N, Fewtrell M, Fidler Mis N, Franz A, Goulet O, Hartman C, Hill S, Hojsak I, Iacobelli S, Jochum F, Joosten K, Kolaček S, Koletzko B, Ksiazyk J, Lapillonne A, Lohner S, Mesotten D, Mihályi K, Mihatsch WA, Mimouni F, Mølgaard C, Moltu SJ, Nomayo A, Picaud JC, Prell C, Puntis J, Riskin A, Saenz De Pipaon M, Senterre T, Shamir R, Simchowitz V, Szitanyi P, Tabbers MM, Van Den Akker CH, Van Goudoever JB, Van Kempen A, Verbruggen S, Wu J, Yan W. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium. Clin Nutr 2018; 37:2360-2365. [DOI: 10.1016/j.clnu.2018.06.950] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
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Aluminum and Phthalates in Calcium Gluconate: Contribution From Glass and Plastic Packaging. J Pediatr Gastroenterol Nutr 2017; 64:109-114. [PMID: 27111341 DOI: 10.1097/mpg.0000000000001243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass-packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container-packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity. METHODS Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic-packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers. RESULTS The initial aluminum concentration was approximately 5000 μg/L in the 2 glass-packaged products and approximately 20 μg/L in the plastic-packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates. CONCLUSIONS Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass-packaged product.
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Poole RL, Pieroni KP, Gaskari S, Dixon T, Kerner JA. Aluminum exposure in neonatal patients using the least contaminated parenteral nutrition solution products. Nutrients 2012; 4:1566-74. [PMID: 23201834 PMCID: PMC3509507 DOI: 10.3390/nu4111566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/16/2012] [Accepted: 10/23/2012] [Indexed: 11/23/2022] Open
Abstract
Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN solution products prior to being compounded in the clinical setting [1]. The investigation assessed quantitative Al content of all available products used in the formulation of PN solutions. The objective of this study was to assess the Al exposure in neonatal patients using the least contaminated PN solutions and determine if it is possible to meet the FDA “safe limit” of less than 5 μg/kg/day of Al. The measured concentrations from our previous study were analyzed and the least contaminated products were identified. These concentrations were entered into our PN software and the least possible Al exposure was determined. A significant decrease (41%–44%) in the Al exposure in neonatal patients can be achieved using the least contaminated products, but the FDA “safe limit” of less than 5 μg/kg/day of Al was not met. However, minimizing the Al exposure may decrease the likelihood of developing Al toxicity from PN.
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Affiliation(s)
- Robert L. Poole
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - Kevin P. Pieroni
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304, USA; (K.P.P.); (J.A.K.)
| | - Shabnam Gaskari
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - Tessa Dixon
- Department of Pharmacy, Lucile Packard Children’s Hospital at Stanford, 725 Welch Road, Palo Alto, CA 94304, USA; (S.G.); (T.D.)
| | - John A. Kerner
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304, USA; (K.P.P.); (J.A.K.)
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Poole RL, Pieroni KP, Gaskari S, Dixon TK, Park K, Kerner JA. Aluminum in pediatric parenteral nutrition products: measured versus labeled content. J Pediatr Pharmacol Ther 2012; 16:92-7. [PMID: 22477831 DOI: 10.5863/1551-6776-16.2.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination). METHODS All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration. RESULTS Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products. CONCLUSIONS The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients.
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Gura KM. Aluminum contamination in products used in parenteral nutrition: Has anything changed? Nutrition 2010; 26:585-94. [DOI: 10.1016/j.nut.2009.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 11/16/2022]
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Abstract
BACKGROUND AND OBJECTIVE Aluminum (Al) is associated with significant central nervous system toxicity and bone and liver damage. Because Al is a contaminant of parenteral nutrition (PN) components including calcium and phosphate additives, premature infants are at potentially high risk for toxicity. The US Food and Drug Administration (FDA) has mandated PN component product labeling and recommended maximum Al daily exposure limits. The objective of this article is to determine the actual Al content of neonatal PN solutions, compare these values to the calculated amounts from manufacturers' PN product labels, and ascertain whether the actual Al exposure exceeds the FDA recommended maximum of 5 microg . kg(-1) . day(-1). MATERIALS AND METHODS Samples from 40 neonatal patient PN solutions were selected for sampling and Al content determination. Samples were also taken from 16 manufacturer's component products used in PN formulation. All of the samples were sent to Mayo Laboratories for Al content measurement. The calculated Al concentrations in PN samples were determined from the manufacturer's labeled content. RESULTS Both measured and calculated Al concentrations exceeded the FDA recommended safe limit of <5 microg . kg(-1) . day(-1). The actual measured Al content was significantly lower than the calculated Al content in both the patient PN solutions and the component product samples. CONCLUSIONS Al exposure exceeded the FDA recommended maximum limit for all patient samples; however, the actual measured Al content of all the samples was significantly less than the calculated Al content based on manufacturer's labels. These findings suggest that manufacturers label their products with actual Al content at the time of product release rather than at time of expiration. Periodic monitoring of Al levels should be considered with prolonged PN therapy. Changes in manufacturing processes, including the use of better raw materials, are essential to reduce Al contamination to meet FDA mandates.
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Poole RL, Hintz SR, Mackenzie NI, Kerner JA. Aluminum Exposure From Pediatric Parenteral Nutrition: Meeting the New FDA Regulation. JPEN J Parenter Enteral Nutr 2008; 32:242-6. [DOI: 10.1177/0148607108316187] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert L. Poole
- From Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, California, and Monterey Medical Solutions, Inc, Salinas, California
| | - Susan R. Hintz
- From Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, California, and Monterey Medical Solutions, Inc, Salinas, California
| | - Nicol I. Mackenzie
- From Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, California, and Monterey Medical Solutions, Inc, Salinas, California
| | - John A. Kerner
- From Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, California, and Monterey Medical Solutions, Inc, Salinas, California
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Gura KM, Puder M. Recent developments in aluminium contamination of products used in parenteral nutrition. Curr Opin Clin Nutr Metab Care 2006; 9:239-46. [PMID: 16607123 DOI: 10.1097/01.mco.0000222106.07924.7f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This review evaluates recent developments concerning aluminium contamination of products used in the preparation of parenteral nutrition solutions and the failure of the pharmaceutical industry to respond to these concerns. The difficulty in meeting the intent of the recent US Food and Drug Administration mandate to reduce aluminium exposure with currently available parenteral nutrition additives is addressed. This review also summarizes the issues associated with aluminium toxicity, the patient populations at risk, treatment options, and compounding considerations. RECENT FINDINGS Unfortunately, the published literature detailing the toxicities seen from aluminium exposure in the parenteral nutrition patient are primarily limited to those published in the 1980s and 1990s. Recent publications refer back to these classic papers and discuss the challenges that practitioners face when trying to apply the recommendations of the recently implemented Food and Drug Administration mandate with outdated literature. Few studies have been published to validate those earlier findings. SUMMARY The issues surrounding aluminium toxicity are real and must be addressed. In order to make meaningful changes in clinical practice, low aluminium parenteral nutrition additives are needed and studies must be conducted using currently available products. It remains a challenge to optimize nutritional intake from parenteral nutrition and at the same time reduce aluminium exposure.
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Affiliation(s)
- Kathleen M Gura
- Department of Pharmacy, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Advenier E, Landry C, Colomb V, Cognon C, Pradeau D, Florent M, Goulet O, Ricour C, Corriol O. Aluminum contamination of parenteral nutrition and aluminum loading in children on long-term parenteral nutrition. J Pediatr Gastroenterol Nutr 2003; 36:448-53. [PMID: 12658033 DOI: 10.1097/00005176-200304000-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Children who are receiving parenteral nutrition are at risk of aluminum overload, which may contribute to such side effects as osteopenic bone disease. The aim of the present study is to determine the aluminum contamination of parenteral nutrition solutions and their components, and to assess the aluminum status of children on long-term parenteral nutrition. METHODS Aluminum concentrations were determined by graphite furnace absorption spectroscopy in components and in final parenteral nutrition solutions. The urinary aluminum excretion and plasma aluminum concentration were determined in 10 children on long-term parenteral nutrition. RESULTS The mean aluminum concentration in the administered parenteral nutrition solutions was 1.6 +/- 0.9 micromol x l(-1)(mean +/- standard deviation (SD)). The resulting mean aluminum daily intake of the 10 patients was 0.08 +/- 0.03 micromol x kg(-1) x day(-1). CONCLUSIONS Compared to two previous studies performed in 1990 and in 1995 in our hospital, the aluminum contamination of parenteral nutrition solutions and the daily aluminum intake of the children seemed to decrease. However, the plasma aluminum concentration and daily urinary aluminum excretion of the children still remain above normal standards. The children had no clinical symptoms of bone disease but aluminum accumulation in tissue can not be excluded. To prevent this iatrogenic toxicity, the aluminum contamination of parenteral nutrition should be assessed regularly.
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Affiliation(s)
- Emmanuelle Advenier
- Service de Pharmacie, Hôpital Necker-Enfants Malades, Pharmacie Centrale des Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
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Affiliation(s)
- V Colomb
- Fédération de Pédiatrie, Unité de Gastroentérologie et Nutrition, Hôpital Necker-Enfants Malades, France
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Colomb V, Goulet O. Complications hépatiques de la nutrition artificielle chez l'enfant : stratégies thérapeutiques. NUTR CLIN METAB 1999. [DOI: 10.1016/s0985-0562(99)80057-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Colomb V, Goulet O, Ricour C. Home enteral and parenteral nutrition in children. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1998; 12:877-94. [PMID: 10079911 DOI: 10.1016/s0950-3528(98)90012-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of home enteral and parenteral nutrition programmes is rising rapidly all over the world, in children as in adults. Home artificial nutrition, especially parenteral nutrition, is an expensive technology but is life-saving for many patients. The only possible alternative to home treatment is keeping patients in hospital, and cost-benefit studies have demonstrated that home nutrition is about 70% more cost-effective than hospital-based therapy. Although home nutrition is usually considered by children and families to lead to an improvement in their quality of life, the complications of these techniques, including psychological consequences, have to be carefully assessed and prevented.
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Affiliation(s)
- V Colomb
- Hôpital Necker-Enfants Malades, Fédération de Pédiatrie, Unité de Gastroentérologie et Nutrition, Paris, France
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