Plasma Aluminum Concentrations in Pediatric Patients Receiving Long‐Term Parenteral Nutrition

Courtney‐Martin, Glenda; Kosar, Christina; Campbell, Alison N.; Avitzur, Yaron; Wales, Paul W.; Steinberg, Karen K.; Harrison, Debra; Chambers, Kathryn

doi:10.1177/0148607114531046

Cited by 29 publications

(21 citation statements)

References 31 publications

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“…When peripheral PN is infused, solution' osmolarity of less than 900 mosmol/l reduces the risk of thromboflebitis [102e104] (LOE 3). Pediatric patients receiving long-term PN are at risk for aluminium toxicity and consequential MBD even at present [113,114] (LOE 2þþ). Neonates who are exposed to parenteral aluminum intake may have reduced lumbar spine and hip bone mass during adolescence, which may predispose to osteoporosis and hip fracture later in life [115] (LOE 1À).…”

Section: Osmolaritymentioning

confidence: 99%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

et al. 2018

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Section: Osmolaritymentioning

confidence: 99%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

et al. 2018

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“…19 When plasma aluminum concentrations were measured in patients with intestinal failure who were receiving long-term parenteral nutrition, the average concentration was 8 times greater than that in healthy controls. 20 The aluminum concentrations present in smallvolume parenteral nutrition solutions have not changed since the studies that revealed a developmental effect were published. Unfortunately, until new parenteral components with lower aluminum content are available, no matter how thoughtful the prescriber, parenteral nutrition solutions for most pediatric patients will contain aluminum concentrations above the recommended amount.…”

Section: Regulatory Responsementioning

confidence: 99%

Aluminum Effects in Infants and Children

Corkins

2019

Pediatrics

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Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and smallvolume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.

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“…The contamination of aluminum in PN solutions has been a concern as aluminum toxicity can cause bone disease, neurological impairment, liver disease, and anemia even years after initial exposure . Although aluminum content in PN has significantly decreased in the last years, high aluminum levels are still reported in children receiving PN . Calcium and phosphate salts and multivitamin and trace element solutions are now the primary sources for aluminum contamination in PN .…”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

“…Calcium and phosphate salts and multivitamin and trace element solutions are now the primary sources for aluminum contamination in PN . The US Food and Drug Administration has advised that PN solutions are required to contain <25 mcg/L of aluminum with a daily intake of <5 mcg/kg/day . PN solutions should be labeled with the maximum aluminum content in home PN patients and in inpatients receiving PN, especially neonates due to immature kidney function.…”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

Monitoring of long‐term parenteral nutrition in children with intestinal failure

Zemrani

Bines

2019

JGH Open

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Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

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Plasma Aluminum Concentrations in Pediatric Patients Receiving Long‐Term Parenteral Nutrition

Abstract: Pediatric patients receiving long-term PN for IF in Canada are at risk for Al toxicity.

Cited by 29 publications

References 31 publications

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

Aluminum Effects in Infants and Children

Monitoring of long‐term parenteral nutrition in children with intestinal failure

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