Lima-Rogel Victoria, Romano-Moreno Silvia, de Jesús López-López Esperanza, de Jesús Escalante-Padrón Francisco, Hurtado-Torres Gilberto Fabian
Neonatology Unit, Hospital Central Dr Ignacio Morones Prieto and Faculty of Medicine, University of San Luis Potosí, México.
Pharmacy Division, Faculty of Chemistry, University of San Luis Potosí, México.
JPEN J Parenter Enteral Nutr. 2016 Sep;40(7):1014-20. doi: 10.1177/0148607114550001. Epub 2014 Sep 16.
Aluminum contamination from intravenous solutions still represents an unsolved clinical and biochemical problem. Increased aluminum intake constitutes a risk factor for the development to metabolic bone disease, anemia, cholestasis, and neurocognitive alterations. Low-birth-weight preterm infants (LBWPIs) are one of the most exposed populations for aluminum toxicity.
To determine the presence of aluminum in components employed in the preparation of parenteral nutrition (PN) admixtures in Mexico and compare with the maximal aluminum recommended intake from the Food and Drug Administration.
Cysteine, trace elements, levocarnitine, phosphate, and calcium salts tested positive for aluminum contamination. All components analyzed were contained in glass vials. Total aluminum intake for 2 sample PN admixtures were calculated in basis to cover nutrition requirements of 2 hypothetical LBWPIs. Aluminum contents, stratified in micrograms per kilogram of weight, exceeded maximal aluminum recommendations, particularly for the very LBWPIs. Substituting sodium phosphate for potassium phosphate salts reduced aluminum intake by 52.7%. Calcium gluconate was the leading aluminum contamination source and confers the greatest risk for aluminum overdose, even with the salt substitution of potassium phosphate by sodium phosphate salts. Adding cysteine and trace elements might increase aluminum content in PN admixtures.
Cysteine, trace elements, phosphate, and gluconate salts are the main sources of aluminum in PN prepared in Mexico. Substituting sodium phosphate for potassium phosphate salts reduces aluminum intake but does not resolve aluminum contamination risk. Mineral salts contained in plastic vials should be explored as an additional measure to reduce aluminum contamination.
静脉输液中的铝污染仍是一个尚未解决的临床和生化问题。铝摄入量增加是代谢性骨病、贫血、胆汁淤积和神经认知改变发展的危险因素。低体重早产儿是铝中毒最易受影响的人群之一。
测定墨西哥肠外营养（PN）混合制剂所用成分中铝的存在情况，并与美国食品药品监督管理局推荐的最大铝摄入量进行比较。
半胱氨酸、微量元素、左卡尼汀、磷酸盐和钙盐检测出铝污染呈阳性。所有分析的成分均装在玻璃瓶中。根据两名假设的低体重早产儿的营养需求，计算了两种样本PN混合制剂的总铝摄入量。以每千克体重微克数分层的铝含量超过了最大铝推荐量，尤其是对于极低体重早产儿。用磷酸钠替代磷酸钾盐可使铝摄入量减少52.7%。葡萄糖酸钙是主要的铝污染源，即使将磷酸钾盐替换为磷酸钠盐，也会带来铝过量的最大风险。添加半胱氨酸和微量元素可能会增加PN混合制剂中的铝含量。
半胱氨酸、微量元素、磷酸盐和葡萄糖酸盐是墨西哥制备的PN中铝的主要来源。用磷酸钠替代磷酸钾盐可减少铝摄入量，但不能消除铝污染风险。应探索塑料瓶中含有的矿物质盐作为减少铝污染的额外措施。
