Aluminum contamination of parenteral nutrition additives, amino acid solutions, and lipid emulsions

Contamination of parenteral nutrition solutions with aluminum may result in accumulation of this element in bones and, in premature infants, may inhibit bone calcium uptake and induce cholestasis. We measured the aluminum concentration of small-volume parenterals, amino acid solutions, lipid emulsions, and special solutions containing glucose, amino acids, electrolytes, and trace elements (standard I for children with a body weight of 3–5 kg, standard II for children with a body weight of 5–10 kg). The method used was graphite furnace atomic absorption spectrometry GTA-AAS (SpectrAA-400 Plus, Varian, PtY Ltd., Mulgrave, Australia). Quality control was run with the use of control serum (Seronorm, Nycomed, Oslo, Norway). The aluminum contents of parenterally administered solutions were: pediatric trace elements, 130 μg/L, and pediatric trace elements, 3000 μg/L; phosphorus salts: K-phosphates, 9800 μg/L, and Na/K phosphates, 13000 μg/L; 10% calcium gluconate, 4400 μg/L; 6.5% amino acids, 30 μg/L; 10% amino acids, 120 μg/L; 12.5% amino acids, 121 μg/L; 20% lipid emulsion, 30 μg/L; 20% lipid emulsion, 180 μg/L; water-soluble vitamins, 12 μg/L; lipid soluble vitamins, 360 μg/L; standard I, 55 μg/L; standard II, 90 μg/L. The aluminum intake from parenteral nutrition was 6.6–10.8 μg · kg−1 · d−1—a dose exceeding the safety limit of 2 μg · kg−1 · d−1. The possible association of aluminum not only with metabolic bone disease, but also with encephalopathy, dictates caution when dealing with the pediatric population on long-term parenteral nutrition. In the absence of reliable label information, it seems proper to monitor the aluminum concentration in parenteral nutrition products and to report it in professional journals.