Aluminium in parenteral nutrition: a systematic review

Abstract

Aluminium (Al) toxicity problem in parenteral nutrition solutions (PNS) is decades old and is still unresolved. The aim of this review is to gather updated information about this matter, regarding legislation, manifestations, diagnostics and treatment, patient population at risk and the actions to be taken to limit its accumulation. A structured search using MeSH vocabulary and Title/Abstract searches was conducted in PubMed (http://www.pubmed.gov) up to November 2012. Al is ubiquitous, facilitating its potential for exposure. Nevertheless, humans have several mechanisms to prevent significant absorption and to aid its elimination; therefore, the vast majority of the population is not at risk for Al toxicity. However, when protective gastrointestinal mechanisms are bypassed (for example, parenteral fluids), renal function is impaired (for example, adult patients with renal compromise and neonates) or exposure is high (for example, long-term PNS), Al is prone to accumulate in the body, including manifestations such as impaired neurological development, Alzheimer's disease, metabolic bone disease, dyslipemia and even genotoxic activity. A high Al content in PNS is largely the result of three parenteral nutrient additives: calcium gluconate, inorganic phosphates and cysteine hydrochloride. Despite the legislative efforts, some factors make difficult to comply with the rule and, therefore, to limit the Al toxicity. Unfortunately, manufacturers have not universally changed their processes to obtain a lower Al content of parenteral drug products (PDP). In addition, the imprecise information provided by PDP labels and the high lot-to-lot variation make the prediction of Al content rather inaccurate.

Microstructure of Commercial Purity Titanium Subjected to Complex Loading by the Kobo Method

“…Overall mean grain diameter for KoBo extruded grade 2 titanium is equal to 1.48 μm and 8.07 μm for grade 4. those values are also presented in table 2.…”

“…This fact is especially important considering prolonged period of implant functioning. While vanadium cations are known to have cytotoxic response in peri-implant tissues, potentially leading to implant loosening and failure, aluminum cations are considered harmful for their neurotoxicity and connection with Alzheimer disease [4]. Therefore currently, efforts are made to develop titanium based materials without addition of any cytotoxic or neurotoxic elements but with mechanical properties sufficient for bone substitution and, load bearing applications such as in dental implants.…”

Componentes de las mezclas de nutrición parenteral para pediatría

“…El cromo y molibdeno no están incluidos en el Peditrace ® pero las soluciones utilizadas para la preparación de NP pueden aportarlos como contaminantes, al igual que otros elementos como el zinc, cobre, manganeso, boro, aluminio, titanio, bario, vanadio, arsénico y estroncio que se han visto que pueden contaminar la NP en concentraciones mayores a 1 mcg/L (34). La contaminación de las soluciones de NP con aluminio puede dar lugar a cuadros patológicos (35,36). Los recién nacidos, fundamentalmente pretérminos, son mucho más sensibles a concentraciones altas de aluminio por la inmadurez de su función renal.…”

The use of aluminum and its compounds in the biomedical purposes

“…Особливо це стосується вмісту спо-лук алюмінію у питній воді та зростання спо-живання харчових продуктів, які забруднені цим металом [11,13,36]. Нині існують дані, інколи навіть протилежні, щодо токсичності наночастинок сполук алюмінію для клітин різних біооб'єктів [14,18,27,32,33,37,38].…”