Aluminium toxicity parenteral nutrition

Metabolic bone disease in children receiving parenteral nutrition manifests primarily as osteopenia and, on occasion, fractures (5). The etiology is multifactorial calcium and phosphate deficiency play a major role in the preterm infant but the part played by aluminium toxicity in this population is unknown. Lack of reference values of bone histomorphometry in the premature infant, as well as lack of reference data for biochemical markers of bone turnover in these patients, contributes to the uncertainty. Other factors that may play a role in the pathogenesis of bone disease associated with parenteral nutrition include lack of periodic enteral feeding underljdng intestinal disease, including malabsorption and inflammation the presence of neoplasms and drug-induced alterations in calcium and bone metabohsm. However, the true incidence and prevalence of parenteral nutrition-associated bone abnormalities in pediatric patients are unknown. 

Aluminium toxicity has been studied retrospectively in 36 hospitalized adults who had a serum creatinine concentration at least 1.5 times greater than on the first day of parenteral nutrition 12 were undergoing hemodialysis [8 ]. Mean aluminium exposure was 3.8 pg/kg/day in the 36 patients, of whom 29 had safe calculated exposures (5 pg/kg/day) and also significantly higher serum creatinine concentrations than those with high aluminium exposure. The authors suggested that most patients with acute kidney disease who require parenteral nutrition do not receive excessive exposure to aluminium. 

Toxicity The factors which contribute to aluminium toxicity in parenteral nutrition solutions (PNS) have been systematically reviewed [122 ]. The actions of three PNS additives namely, calcium gluconate, inorganic phosphates and cysteine hydrochloride, are largely responsible for increasing the aluminium concentration of PNS, thus increasing the risk of aluminium toxicity. Impaired renal function and long-term administration of PNS are also contributory factors. 

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