Parenteral aluminium loading in critical care medicine part I aluminium content of infusion solutions and solutions for parenteral nutrition

Background For patients with disturbed aluminum Al excretion, a high Al intake is not without risk. As main aluminum sources infusion solutions and solutions for parenteral nutrition have been identified. This study will give current survey of aluminum loading of the above mentioned preparations. Material and Methods The aluminum loading of 139 different infusion solutions and solutions for parenteral nutrition was determined. The solutions were from the clinical pharmacy of the Klinikum Steglitz of the Free University Berlin or were bought in a public pharmacy. The aluminum content was determined by means of two different, independent analytical methods a graphite furnace atomic absorption spectroscopy GFAAS and b inductively coupled plasma atomic emission spectroscopy ICP AES . The agreement of the measured values was good except for five samples, where different values were found. Mistakes due to contamination were excluded on the basis of the results of measuring standard reference materials. Results Small volume additives of TPN total parenteral nutrition formulations were highly contaminated with aluminum, e.g. Ca and phosphate solutions 29 12,000 g l , vitamin C solutions 700 1,200 g l and trace element solutions 67 6,200 g l . Furthermore about 44 of the crystalline amino acid solutions and lipid emulsions had an aluminum content of 25 to 55 g l. Low aluminum levels were found in carbohydrate solutions, NaCl and KC1 solutions and in distilled water aqua ad injectabilia . Conclusions Many of the solutions for parenteral nutritional support have an aluminum content which exceeds, in part considerably, the suggested threshold concentration of 25 g l 0.93 mol l , recommended by the American Society for Clinical Nutrition ASCN and the American Society for Parenteral and Enteral Nutrition ASPEN . The pharmaceutical industry should be required to check the manufacturing process for avoidable sources of contamination, and threshold values for aluminum loading by intravenously applied pharmaceuticals should be laid down in the German and European pharmacopeia. In cases where contaminations cannot be eliminated during the manufacturing process after careful checking, the aluminum content of the infusion solution should be declared for the use