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Aluminum and Phthalates in Calcium Gluconate: Contribution From Glass and Plastic Packaging. J Pediatr Gastroenterol Nutr 2017; 64:109-114. [PMID: 27111341 DOI: 10.1097/mpg.0000000000001243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass-packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container-packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity. METHODS Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic-packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers. RESULTS The initial aluminum concentration was approximately 5000 μg/L in the 2 glass-packaged products and approximately 20 μg/L in the plastic-packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates. CONCLUSIONS Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass-packaged product.
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Findlow JA, Duffield JR, Williams DR. The chemical speciation of aluminium in milk. CHEMICAL SPECIATION & BIOAVAILABILITY 2015. [DOI: 10.1080/09542299.1990.11083122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- G L Klein
- Associate Professor of Pediatrics and Nutrition, University of Texas Medical Branch, Galvesto, TX 77550-2776, USA
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Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence. Proc Nutr Soc 2011; 70:299-304. [DOI: 10.1017/s0029665111000498] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high – all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13–15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.
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Fewtrell MS, Bishop NJ, Edmonds CJ, Isaacs EB, Lucas A. Aluminum exposure from parenteral nutrition in preterm infants: bone health at 15-year follow-up. Pediatrics 2009; 124:1372-9. [PMID: 19858156 DOI: 10.1542/peds.2009-0783] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Aluminum has known neurotoxicity and may impair short-term bone health. In a randomized trial, we showed reduced neurodevelopmental scores in preterm infants who were previously exposed to aluminum from parenteral nutrition solutions. Here, in the same cohort, we test the hypothesis that neonatal aluminum exposure also adversely affects long-term bone health, as indicated by reduced bone mass. METHODS Bone area (BA) and bone mineral content (BMC) of lumbar spine, hip, and whole body were measured with dual radiograph absorptiometry in 13- to 15-year-olds who were born preterm and randomly assigned standard or aluminum-depleted parenteral nutrition solutions during the neonatal period. RESULTS Fifty-nine children (32% of survivors) were followed. Those who were randomly assigned to standard parenteral nutrition solution had lower lumbar spine BMC, apparently explained by a concomitant decrease in bone size. In nonrandomized analyses, children who were exposed to neonatal aluminum intakes above the median (55 microg/kg) had lower hip BMC (by 7.6% [95% confidence interval: 0.12-13.8]; P = 0.02), [corrected] independent of bone (or body) size. CONCLUSIONS Neonates who are exposed to parenteral aluminum may have reduced lumbar spine and hip bone mass during adolescence, potential risk factors for later osteoporosis and hip fracture. These findings need confirmation in larger, more detailed studies. Nevertheless, given our previous finding of adverse developmental outcome in these individuals and the sizeable number of contemporary infants who undergo intensive neonatal care and are still exposed to aluminum via parenteral feeding solutions, the potential adverse long-term consequences of early aluminum exposure now deserve renewed attention.
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Affiliation(s)
- Mary S Fewtrell
- Medical Research Council Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom.
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Greger JL. Dietary and other sources of aluminium intake. CIBA FOUNDATION SYMPOSIUM 2007; 169:26-35; discussion 35-49. [PMID: 1490425 DOI: 10.1002/9780470514306.ch3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aluminium in the food supply comes from natural sources including water, food additives, and contamination by aluminium utensils and containers. Most unprocessed foods, except for certain herbs and tea leaves, contain low (< 5 micrograms Al/g) levels of aluminium. Thus most adults consume 1-10 mg aluminium daily from natural sources. Cooking in aluminium containers often results in statistically significant, but not practically important, increases in the aluminium content of foods. Intake of aluminium from food additives varies greatly (0 to 95 mg Al daily) among residents in North America, with the median intake for adults being about 24 mg daily. Generally, the intake of aluminium from foods is less than 1% of that consumed by individuals using aluminium-containing pharmaceuticals. Currently the real scientific question is not the amount of aluminium in foods but the availability of the aluminium in foods and the sensitivity of some population groups to aluminium. Several dietary factors, including citrate, may affect the absorption of aluminium. Aluminium contamination of soy-based formulae when fed to premature infants with impaired kidney function and aluminium contamination of components of parenteral solutions (i.e. albumin, calcium and phosphorus salts) are of concern.
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Affiliation(s)
- J L Greger
- Department of Nutritional Sciences, University of Wisconsin, Madison 53706
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Acute Aluminum Intoxication. STRUCTURE AND BONDING 2002. [DOI: 10.1007/3-540-45425-x_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Buchman AL, Neely M, Grossie VB, Truong L, Lykissa E, Ahn C. Organ heavy-metal accumulation during parenteral nutrition is associated with pathologic abnormalities in rats. Nutrition 2001; 17:600-6. [PMID: 11448580 DOI: 10.1016/s0899-9007(01)00544-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Metabolic bone disease, hepatic abnormalities, splenic insufficiency, and nephropathy have been associated with long-term total parenteral nutrition (TPN). We determined the heavy-metal contamination in TPN solutions and investigated whether it was associated with organ deposition and pathologic organ damage. METHODS Five representative TPN solutions (two adult standard solutions, one renal solution, and one standard pediatric solution to reflect clinical practice) and 28 TPN components were analyzed with inductively coupled plasma mass spectrometry. Twenty-six male Fisher 344 rats were assigned to two groups (chow/NaCl = 8 and TPN = 18). TPN or NaCl was infused at a rate of 50 mL/d. After 14 d, serum, femurs, spine, liver, kidneys, brain, spleen, and testes were analyzed for heavy-metal deposition by using inductively coupled plasma mass spectrometry. Tissues were fixed in formalin, sectioned, and stained with hematoxylin and eosin, periodic acid Schiff, and Masson's trichrome stain. Kidneys were fixed in gluteraldehyde for ultrastructural examination with scanning electron microscopy. RESULTS The predominant sources of contaminants in TPN were amino acids (Al, As, Cr, Ge, Pb, Sn), dextrose (As, Ba, Cr, Sn), Ca gluconate (Al), K2PO4 (Al), lipid emulsion (As, Sn), and vitamins (As). Significant variations in the level of contamination depended on TPN formulation and brand of constituents. In the kidney, Pb, Cr, and Mn concentrations were greater than in controls, although there was no correlation with serum creatinine. Hepatic Cr and Pb concentrations were greater in TPN rats, although there was no correlation with serum aspartate aminotransferase or total bilirubin. Splenic Ba, Cr, Ge, Pb, Mn, and Sn concentrations were greater in TPN rats. Only serum Cr concentration was significantly correlated with splenic concentration (r = 0.46, P = 0.04). Brain and serum Ba concentrations were significantly correlated (r = 0.60, P = 0.007). No significant correlations were observed between any other metal in serum and that metal's respective organ concentration. No increase in heavy-metal accumulation was seen in the femur, spine, or testis. There were no significant depositions of As, Cd, Hg, St, or V in any of the organs examined. Serum Al and Cr concentrations were significantly increased in TPN rats, although there was no correlation with tissue concentrations. No significant increases in heavy-metal concentrations in tissue or plasma were observed for any of the other metals measurable by inductively coupled plasma mass spectrometry. Histologically in the TPN group, 50% of the rats had mild to moderate hepatic steatosis and 33% to 50% developed renal morphologic abnormalities; brains and spleens remained histologically normal. CONCLUSIONS We found significant heavy-metal contamination of TPN solutions, and this contamination can lead to organ deposition and subsequent histologic abnormalities.
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Affiliation(s)
- A L Buchman
- Division of Gastroenterology and Hepatology, Northwestern University Medical School, Chicago, Illinois, USA.
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Fernandez-Lorenzo JR, Cocho JA, Rey-Goldar ML, Couce M, Fraga JM. Aluminum contents of human milk, cow's milk, and infant formulas. J Pediatr Gastroenterol Nutr 1999; 28:270-5. [PMID: 10067727 DOI: 10.1097/00005176-199903000-00011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aluminum toxicity is well documented and contamination of milk formulas has been implicated as the source of accumulation in bone and brain tissues. The purpose of the current study was to evaluate the aluminum contents of human milk, cow's milk, and infant formulas. METHODS Aluminum contents were determined by atomic absorption spectrometry in samples of human milk in the colostrum, intermediate, and mature stages; infant formulas from eight manufacturers; and various types and brands of commercially available cow's milk. RESULTS Mean aluminum concentration was lowest in human milk (23.4 +/- 9.6 microg/l), and did not differ significantly between colostrum, intermediate-stage and mature-stage milk. Mean aluminum concentration was 70 microg/l in cow's milk, and 226 microg/l in reconstituted infant formulas. Aluminum concentrations in infant formulas differed markedly among manufacturers; concentration in milk from one of the manufacturers was particularly high (mean, 551 microg/l; range, 302-1149 microg/l). These values are for milk reconstituted with aluminum-free water under laboratory conditions; formulas prepared with tap water in the University Hospital's infant-feeding unit had even higher aluminum content. Experiments showed that aluminum concentration in the high-aluminum milk could be reduced by more than 70% at the manufacturing stage, by using low aluminum components. CONCLUSIONS The results of the present study support the recommendations for infant formula manufacturers to strive to reduce aluminum concentration in their products.
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Affiliation(s)
- J R Fernandez-Lorenzo
- Service of Neonatology and Metabolic and Nutritional Laboratory, Hospital Xeral de Galicia, Santiago de Compostela, Spain
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Abstract
Aluminum (Al) is a nonessential, toxic metal to which humans are frequently exposed. Oral exposure to aluminum occurs through ingestion of aluminum-containing pharmaceuticals and to a lesser extent foods and water. Parenteral exposure to aluminum can occur via contaminated total parenteral nutrition (TPN), intravenous (i.v.) solutions, or contaminated dialysates. Inhalation exposure may be important in some occupational settings. The gut is the most effective organ in preventing tissue aluminum accumulation after oral exposure. Typically gastrointestinal absorption of aluminum from diets is < 1%. Although the mechanisms of aluminum absorption have not been elucidated, both passive and active transcellular processes and paracellular transport are believed to occur. Aluminum and calcium may share some absorptive pathways. Aluminum absorption is also affected by the speciation of aluminum and a variety of other substances, including citrate, in the gut milieu. Not all absorbed or parenterally delivered aluminum is excreted in urine. Low glomerular filtration of aluminum reflects that most aluminum in plasma is nonfiltrable because of complexation to proteins, predominantly transferrin. The importance of biliary secretion of aluminum is debatable and the mechanism(s) is poorly understood and appears to be saturable by fairly low oral doses of aluminum.
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Affiliation(s)
- J L Greger
- Department of Nutritional Sciences, University of Wisconsin, Madison 53706, USA
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Viñas P, Campillo N, López-Garcı́a I, Hernández-Córdoba M. Electrothermal atomic absorption spectrometric determination of molybdenum, aluminium, chromium and manganese in milk. Anal Chim Acta 1997. [DOI: 10.1016/s0003-2670(97)00553-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bishop NJ, Morley R, Day JP, Lucas A. Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions. N Engl J Med 1997; 336:1557-61. [PMID: 9164811 DOI: 10.1056/nejm199705293362203] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aluminum, a contaminant of commercial intravenous-feeding solutions, is potentially neurotoxic. We investigated the effect of perinatal exposure to intravenous aluminum on the neurologic development of infants born prematurely. METHODS We randomly assigned 227 premature infants with gestational ages of less than 34 weeks and birth weights of less than 1850 g who required intravenous feeding before they could begin enteral feeding to receive either standard or specially constituted, aluminum-depleted intravenous-feeding solutions. The neurologic development of the 182 surviving infants who could be tested was assessed by using the Bayley Scales of Infant Development at 18 months of age. RESULTS The 90 infants who received the standard feeding solutions had a mean (+/-SD) Bayley Mental Development Index of 95+/-22, as compared with 98+/-20 for the 92 infants who received the aluminum-depleted solutions (P=0.39). In a planned subgroup analysis of infants in whom the duration of intravenous feeding exceeded the median and who did not have neuromotor impairment, the mean values for the Bayley Mental Development Index for the 39 infants who received the standard solutions and the 41 infants who received the aluminum-depleted solutions were 92+/-20 and 102+/-17, respectively (P=0.02). The former were significantly more likely (39 percent, vs. 17 percent of the latter group; P=0.03) to have a Mental Development Index of less than 85, increasing their risk of subsequent educational problems. For all 157 infants without neuromotor impairment, increasing aluminum exposure was associated with a reduction in the Mental Development Index (P=0.03), with an adjusted loss of one point per day of intravenous feeding for infants receiving the standard solutions. CONCLUSIONS In preterm infants, prolonged intravenous feeding with solutions containing aluminum is associated with impaired neurologic development.
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Affiliation(s)
- N J Bishop
- Medical Research Council (MRC) Dunn Nutrition Unit, Cambridge, United Kingdom
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Parenteral drug products containing aluminum as an ingredient or a contaminant: response to Food and Drug Administration notice of intent and request for information. ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions. JPEN J Parenter Enteral Nutr 1991; 15:194-8. [PMID: 1904955 DOI: 10.1177/0148607191015002194] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aluminum remains a significant contaminant of total parenteral nutrition (TPN) solutions and may be elevated in bone, urine, and plasma of infants receiving TPN. Aluminum accumulation in tissues of uremic patients and adult TPN patients has been associated with low-turnover bone disease. Furthermore, aluminum has also been linked with encephalopathy and anemia in uremic patients and with hepatic cholestasis in experimental animals. Because of the toxic effects of aluminum, the Food and Drug Administration (FDA) recently published a notice of intent to set an upper limit of 25 micrograms/L for aluminum in large-volume parenterals and to require manufacturers of small-volume parenterals, such as calcium and phosphate salts, to measure aluminum content and note this content on the package label. The ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions supports these intentions and further urges the FDA to require that cumulative aluminum intake in terms of safe, unsafe, and toxic quantities of aluminum per kilogram be made known to physicians and pharmacists preparing the TPN solutions, to ensure that manufacturers use appropriate control procedures in aluminum measurements, and to employ a standard unit of aluminum measurement.
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Abstract
Aluminum contaminates several chemical compounds that are administered intravenously to patients. The most highly contaminated are calcium and phosphate salts, followed by albumin and heparin. Parenteral administration of aluminum bypasses the gastrointestinal tract, which serves as a protective barrier to aluminum entry into the blood. In the past, parenteral administration of aluminum as a contaminant of water used in hemodialysis and of casein hydrolysate, the former source of protein in parenteral nutrition solutions, was associated with a low-turnover osteomalacic bone disease and, in the case of uremic patients, encephalopathy. Groups currently at risk for aluminum accumulation in tissue resulting from parenteral administration include premature infants receiving long-term parenteral nutrition and patients receiving plasmapheresis therapy with albumin. Both groups may develop metabolic bone disease; the pathogenesis may involve aluminum. The Food and Drug Administration is currently considering regulation of aluminum in fluids used for parenteral nutrition. No changes are presently proposed with regard to albumin.
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Affiliation(s)
- G L Klein
- Department of Pediatrics, University of Texas Medical Branch, Galveston 77550-2776
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Larchet M, Chaumont P, Galliot M, Bourdon R, Goulet O, Ricour C. Aluminium loading in children receiving long-term parenteral nutrition. Clin Nutr 1990; 9:79-83. [PMID: 16837336 DOI: 10.1016/0261-5614(90)90057-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/1988] [Accepted: 09/14/1989] [Indexed: 11/26/2022]
Abstract
Eight children on long-term, total parenteral nutrition (TPN) were found to have elevated aluminium (Al) levels in plasma (51 +/- 11 microg 1/1), urine (223 +/- 78 microg 24 h) and bone. The load of Al in TPN solution was 232 +/- 89 microg/day, and, among the different parenteral solution components high Al concentrations were found in amino-acids, calcium gluconate, potassium lactate, and trace elements, representing respectively 40%, 30%, 15%, and 10% of the total Al intakes. The authors conclude that children receiving long-term TPN have excessive Al intakes and are exposed to Al toxicity. The prevention of Al contamination requires careful control of the TPN components.
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Affiliation(s)
- M Larchet
- Service de réanimation Digestive et d'Assistance Nutritive et, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Daydé S, Filella M, Berthon G. Aluminum speciation studies in biological fluids. Part 3. Quantitative investigation of aluminum-phosphate complexes and assessment of their potential significance in vivo. J Inorg Biochem 1990; 38:241-59. [PMID: 2329346 DOI: 10.1016/0162-0134(90)84016-i] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Following the discovery that specific health disorders affecting patients with renal disease were due to their excessive body accumulation of aluminum, it was established that aluminum toxicity was mainly due to the ingestion of aluminum-containing phosphate binders. Suspicion of toxicity was thus cast on aluminum-containing antacids, and subsequent tests held on healthy subjects did reveal that aluminum hydroxide gels were also potential oral sources of aluminum, especially in the presence of citric acid. Nevertheless, authors of these tests concluded that there was only marginal absorption of aluminum phosphate. In contrast with these clinical conclusions, it has recently been contended on theoretical grounds that aluminum phosphate represents a serious health hazard. To help elucidate this issue, this paper first deals with a quantitative investigation of aluminum-phosphate equilibria under physiological conditions. Then appropriate computer simulations based on corresponding results are used to assess the actual extent to which phosphate can influence aluminum bioavailability. These simulations confirm that aluminum phosphate is not expected to induce absorption of high amounts of aluminum when administered by itself. Nevertheless, this result may no longer apply in the presence of food, whose various acidic components are likely to modify the involved chemical equilibria. Moreover, it is shown that rising blood plasma phosphate levels should tend to increase aluminum tissue penetration and hence favor its potential toxicity.
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Affiliation(s)
- S Daydé
- INSERM U305, Equipe Bioréactifs: Spéciation et Biodisponibilité, Université Paul Sabatier, Toulouse, France
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Dabeka RW, McKenzie AD. Aluminium levels in Canadian infant formulate and estimation of aluminium intakes from formulae by infants 0-3 months old. FOOD ADDITIVES AND CONTAMINANTS 1990; 7:275-82. [PMID: 2354745 DOI: 10.1080/02652039009373892] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aluminium was determined in 282 cans of infant formulae and evaporated milks sold in Canada using graphite furnace atomic absorption spectrometry. Milk-based formulae contained average (range) concentrations of 0.129 (0.010-0.36), 0.217 (0.17-0.56) and 0.717 (0.19-2.49) micrograms/g ('as sold') in ready-to-use, concentrated liquid and powder formulae, respectively. The corresponding concentrations in the soy-based formulae were 1.98 (0.40-6.4), 1.41 (0.59-2.29) and 9.44 (3.15-18.0) micrograms/g. Evaporated milk contained 0.093 (0.022-0.34) micrograms/g. The levels varied extensively according to formula brand; e.g. for ready-to-use formulae, the range of average concentrations by formula brand were 0.42-3.28 micrograms/g for soy-based and 0.020-0.22 micrograms/g for milk-based products. Estimated aluminium ingestion from formula or milk by infants up to 3 months old ranged from 0.5 microgram per kg body weight per day (microgram/kg/day) or 2 micrograms/day for 0-1 month olds fed cow milk exclusively to 219 micrograms/kg/day (1260 micrograms/day) for 1-3 month olds fed only soy-based formulae. Consumption of only the formulae brand having the highest mean aluminium level (3.28 micrograms/g) by 1-3 month old infants could result in an intake of 363 micrograms/kg/day (2088 micrograms/day). The estimates assume that the sole source of aluminium is the formula or milk and do not include any potential contribution from other foods or water.
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Affiliation(s)
- R W Dabeka
- Food Research Division, Health and Welfare Canada, Ottawa, Ontario
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Venturini M, Berthon G. Aluminum speciation studies in biological fluids. Part 2. Quantitative investigation of aluminum-citrate complexes and appraisal of their potential significance in vivo. J Inorg Biochem 1989; 37:69-90. [PMID: 2795001 DOI: 10.1016/0162-0134(89)80031-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Because of the recent implications of aluminum in the pathogenesis of various disease states, its in vivo chemistry has been receiving growing attention from bioinorganic chemists over the last few years. In this context, the elucidation of the main factors that govern aluminum bioavailability constitutes an urgent objective. Clearly, prevention measures require that mechanisms of aluminum absorption be definitely characterized, whereas specific sequestering agents are needed to detoxify patients with high-aluminum-body burdens. In particular, speciation studies are necessary to discriminate among the chemical forms under which aluminum predominates in vivo. Low molecular weight (LMW) species, which are the most active in terms of bioavailability, cannot be assessed by analytical techniques, and so computer simulations must be used. In recent clinical studies as well as in preliminary simulations dealing with aluminum distribution in blood plasma, citrate has been recognized as the most important LMW ligand of aluminum. The present paper thus reports a quantitative investigation of aluminum-citrate equilibria, carried out at 37 degrees C in NaCl 0.15 mol dm-3 in accordance with the experimental protocol defined in our previous study on aluminum hydrolysis. The ML, MLH, ML2, M3L3H-4, M2L2H-2, ML2H-1, and ML2H-2 species have been characterized over the whole physiological pH range using as large reactant concentration ratios as possible. Corresponding formation constants have then been used to investigate the role of citrate towards aluminum bioavailability. Blood plasma simulations reveal that citrate can promote aluminum urinary excretion, which substantiates recent clinical observations made on mice. However, the higher plasma aluminum concentrations are, the less effective citrate is to be expected. Gastrointestinal simulations confirm that the electrically neutral ML complex does represent an important risk of aluminum absorption in the upper region of the gastrointestinal tract at usual therapeutic doses. At moderate- and low-aluminum concentrations, citrate is also capable of dissolving the aluminum trihydroxide precipitate, which may combine with the capacity of other ligands to complex Al3+ into absorbable complexes at less acidic pH.
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Affiliation(s)
- M Venturini
- Inserm U305, Equipe Bioréactifs: Spéciation et Biodisponibilité, Université Paul Sabatier, Toulouse, France
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Pavanetto F, Genta I, Conti B, Modena T, Montanari L. Aluminium, cadmium and lead in large volume parenterals: contamination levels and sources. Int J Pharm 1989. [DOI: 10.1016/0378-5173(89)90333-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bishop NJ, Robinson MJ, Lendon M, Hewitt CD, Day JP, O'Hara M. Increased concentration of aluminium in the brain of a parenterally fed preterm infant. Arch Dis Child 1989; 64:1316-7. [PMID: 2510611 PMCID: PMC1792721 DOI: 10.1136/adc.64.9.1316] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Parenteral feeding solutions currently used for preterm infants are contaminated with aluminium. We report the case of an infant who was fed parenterally for 45 days, who died aged 3 months, and who had a considerably increased concentration of aluminium in his brain tissue at necropsy.
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Daniell AJ, Darlow BA. Audit of drug usage in a regional neonatal intensive care unit. AUSTRALIAN PAEDIATRIC JOURNAL 1989; 25:207-10. [PMID: 2590115 DOI: 10.1111/j.1440-1754.1989.tb01457.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Drug utilization has been audited prospectively for all infants cared for in a regional neonatal intensive care unit for a 3-month period. Twenty-five infants had a birthweight less than 1500 g and 54 had a birthweight greater than 1500 g. The total number of different drugs used was 76 and the mean number received was 8.6 with a range of 0-30. Infants with birthweights less than 1500 g received a mean of 14.5 drugs and infants with birthweights greater than 1500 g received a mean of 4.8 drugs. Almost two-thirds (63%) of doses were given orally, 20% intravenously and 10% via an umbilical artery catheter. Three drugs, one of which was received by 13% of infants, carried manufacturers' inserts advising against use in premature infants or the newborn.
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Affiliation(s)
- A J Daniell
- Department of Paediatrics, Christchurch School of Medicine, Christchurch Hospital, New Zealand
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Wills MR, Savory J. Aluminum and chronic renal failure: sources, absorption, transport, and toxicity. Crit Rev Clin Lab Sci 1989; 27:59-107. [PMID: 2647415 DOI: 10.3109/10408368909106590] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In normal subjects the gastrointestinal tract is a relatively impermeable barrier to aluminum with a low fractional absorption rate for this metal ion. Aluminum absorbed from the gastrointestinal tract is normally excreted by the kidneys; in the presence of impaired renal function aluminum is retained and accumulates in body tissues. Aluminum-containing medications are given, by mouth, to patients with chronic renal failure as phosphate-binding agents for the therapeutic control of hyperphosphatemia. Patients with chronic renal failure are also exposed to aluminum in domestic tap-water supplies used either for drinking or, in those on dialysis treatment, in the preparation of their dialysate. In patients with end-stage chronic renal failure, particularly in those on treatment by hemodialysis, the accumulation of aluminum in bone, brain, and other tissues is associated with toxic sequelae. An increased brain content of aluminum appears to be the major etiological factor in the development of a neurological syndrome called either "dialysis encephalopathy" or "dialysis dementia"; an increased bone content causes a specific form of osteomalacia. An excess of aluminum also appears to be an etiological factor in a microcytic, hypochromic anemia that occurs in some patients with chronic renal failure on long-term treatment with hemodialysis. The various mechanisms involved in the toxic phenomena associated with the accumulation of aluminum in body tissues have not been clearly defined but are the subject of extensive investigations.
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Affiliation(s)
- M R Wills
- Department of Pathology and Internal Medicine, University of Virginia Health Sciences Center, Charlottesville
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Köppel C, Baudisch H, Ibe K. Inadvertent metal loading of critically ill patients with acute renal failure by human albumin solution infusion therapy. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1988; 26:337-56. [PMID: 3193488 DOI: 10.1080/15563658809167098] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent reports on the metal contamination of human albumin solutions (HAS) have raised concern about possible medical implications. Large amounts of HAS are infused to premature babies with respiratory distress syndrome, patients with plasmapheresis treatment or acute renal failure. For assessment of the risk of metal loading in patients with acute renal failure, commercially available HAS were analyzed for aluminium, nickel, chromium, manganese, cobalt, zinc, copper, cadmium, lead, and mercury. A considerable contamination of HAS was found for Al, Ni, Cr, Mn, and in part for Co. Additionally, the influence of 3 weeks of daily HAS infusion on metal blood levels was studied in 8 critically ill patients with acute renal failure, protein catabolism, ventilator therapy and hemodialysis treatment. Since most metals are primarily eliminated with the urine, these patients seemed to be at high risk for metal loading. In all patients, a considerable increase in the blood concentrations of Al, Ni, Cr, and in some patients of Mn and Co was found. In addition, the daily dose of Al, Ni, Cr, Mn, and Co by HAS was calculated for the 21st day after start of HAS infusion. In most patients, the dose of Al, Ni, and Cr considerably exceeded (up to a factor of 10) the average daily metal dose absorbed from the diet by healthy subjects. The increase in Mn and Co blood levels, despite a low dose of Mn and Co with the daily HAS infusion, was most likely caused by depletion of Mn and Co tissue stores due to the catabolic state of the patients. The contamination of HAS probably originated from the use of aluminum hydroxide and from contact of plasma with stainless steel surfaces during the Cohn fractionation process. The high extent of contamination of HAS with Al, Ni and Cr cannot be accepted since it is already technically feasible to produce HAS with metal concentrations comparable to the normal serum level range.
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Affiliation(s)
- C Köppel
- Reanimationszentrum, Klinikum Rudolf Virchow, Standort Charlottenburg, Freie Universität Berlin, Federal Republic of Germany
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Robinson MJ, Ryan SW, Newton CJ, Day JP, Hewitt CD, O'Hara M. Blood aluminium levels in preterm infants fed parenterally or with cows' milk formulae. Lancet 1987; 2:1206. [PMID: 2890825 DOI: 10.1016/s0140-6736(87)91338-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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