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Aluminum in Subjects Receiving Parenteral Nutrition

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Diet and Nutrition in Critical Care

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Abstract

Al is ubiquitous, facilitating potential exposure to this element. Nevertheless, its poor absorption via the gastrointestinal tract protects the vast majority of the population from the risk of Al loading and toxicity. However, when the protective gastrointestinal mechanism is bypassed, as occurs in parenteral nutritional therapy, Al is prone to accumulate in the body. Due to this accumulation, Al is implicated in metabolic bone disease associated with parenteral nutrition in both pediatric and adult patients. Neonates are at an increased risk of aluminum toxicity because of anatomic, physiologic, and nutrition-related factors not present in other populations. Regulatory agencies recommended restricting parenteral aluminum administration to less than 5 μg/kg/day, and the US Food and Drug Administration requires that additives used to compound parenteral nutrition (PN) have the maximum aluminum content at the date of expiration listed on the product label and that large-volume parenterals contain no more than 25 μg/L aluminum. Despite legislative efforts, some factors make it difficult to comply with this rule, and therefore, with the current products used to compound formulations for nutritional therapy, the limits are rarely achieved.

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Abbreviations

EDTA:

Ethylenediaminetetraacetic acid

FAO:

Food and Agriculture Organization

FDA:

Food and Drug Administration

IV:

Intravenous

MDI:

Mental Development Index

MHRA:

Medicine and Healthcare Products Regulatory Agency

NICU:

Neonatal intensive care unit

NOAEL:

No-observed-adverse-effect level

PN:

Parenteral nutrition

PTH:

Parathyroid hormone

PTWI:

Provisional tolerable weekly intake

TPN:

Total parenteral nutrition

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Chemistry, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, 97110-900, Brazil

    Denise Bohrer

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  1. Denise Bohrer
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Correspondence to Denise Bohrer .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Bohrer, D. (2014). Aluminum in Subjects Receiving Parenteral Nutrition. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_77-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_77-1

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