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Journal of Trace Elements in Medicine and Biology 21 (2007) S1, 29–30

www.elsevier.de/jtemb

THIRD INTERNATIONAL FESTEM SYMPOSIUM

Electrothermal atomic absorption spectrometry determination of

aluminium in parenteral nutrition and its components

Laura Alvarez, Maira Rebollido, Jose Ramon Fernandez-Lorenzo,Jose Angel Cocho�, Jose Maria Fraga

Laboratorio de Metabolopatias, Hospital Clınico Universitario de Santiago, c/Choupana s/n, 15706 Santiago de Compostela. Spain

Received 25 June 2007; accepted 20 August 2007

Abstract

Aluminium concentration in samples of total parenteral nutrition solutions and samples of their individualcomponents were analysed to know the exposure to this element. The median aluminium content obtained for the totalparenteral nutrition solutions was 105.7 mg/L; for their individual components, 10% calcium gluconat and 1Mmonopotasic phosphate were the most contaminated, as well as the 1M sodium bicarbonate. The great variabilityfound in the aluminium content of solutions suggests that contamination occurs during the manufacturing process.r 2007 Elsevier GmbH. All rights reserved.

Keywords: Aluminium; Total parenteral nutrition; ETAAS; Endovenous therapy

Introduction

Aluminium toxicity includes: metabolic bone disease,encephalopathy, microcytic anaemia, hepatic altera-tions, renal osteodystrophy and neurological alterationssuch as Alzheimer’s disease [1]. The presence of thiselement as contaminant in parenteral nutrition is wellknown and has been discussed in the literature [2].

Premature newborns receiving endovenous therapyare patients with a high risk of suffering aluminiumoverload by the parenteral exposure to this element [3].This way of entry avoids the intestinal barrier and therenal immaturity of newborns impairs its elimination [4].

Certain substances when stored in glass containershave a leaching action and aluminium can be releasedinto the solutions and also aluminium can be present ascontaminant from some pharmaceutical products [5].

ee front matter r 2007 Elsevier GmbH. All rights reserved.

mb.2007.09.009

ing author.

ess: pdneonat@usc.sc (J.A. Cocho).

To know the risk of an aluminium overload, westudied the aluminium concentration in samples of totalparenteral nutrition solutions (TNP) and samples oftheir individual components employed in the NeonatalUnit of our Hospital in the present time.

Material and methods

Two samples of all the 19 TNP solutions and its 14main individual components, almost two differentbatches of all of them, were taken directly from thepackages.

Aluminium analysis was performed in duplicateby electrothermal atomic absorption spectrometry(ETAAS) using a Perkin-Elmer 1100 b spectrometer[6]. Samples were acidified before analysis with 0.1%nitric acid and diluted with 0.2% Triton X-100 assurfactant.

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Table 1. Aluminium content in parenteral nutrition solutions

and their components (mg/L)

Package N Mean SD Range

Parenteral solutions Plastic 19 105.7 42.1 45.1–202.3

Aminoacids 10% Glass 2 5.6 0.1 5.6–5.7

Lipids 20% Glass 6 1.4 0.4 0.8–1.9

Glucose 50% Plastic 7 o1 – –

Potasium acetate 1M Glass 4 0.7 0.17 0.5–0.9

Potasium chloride 1M Plastic 6 16.7 1.6 15.4–19.8

Sodium chloride 20% Plastic 4 13.2 0.5 12.4–13.8

K- Phosphate 1M Plastic 4 333.1 147.9 184–484

Calcium gluconate 10% Glass 7 2711.7 241.7 2240–3040

Oligoelements solutions Plastic 5 95.4 7.5 88.8–104.8

Vitamins mix. Glass 7 47.7 1.7 45.2–51.0

Other intravenous

solutions

Human albumin 20% Glass 6 220.7 12.7 194.5–231.4

Sodium heparin 1% Glass 4 107.8 2.3 105.6–111.6

Tartrate L-noradrenalin Glass 4 285.4 16.2 258.4–301.6

Sodium bicarbonate

1M

Glass 6 772.1 121.9 640.7–899.6

L. Alvarez et al. / Journal of Trace Elements in Medicine and Biology 21 (2007) S1, 29–3030

For the internal quality control, samples of the‘‘Worldwide Inter laboratory Aluminium Quality Con-trol’’ in dialysis water and human plasma (Poitiers,France) were used (Intra run CV 1.5–3.2%, between runCV 3.7% and 6.8%, recovery 97.3% and 109.1%).

Results and discussion

All the obtained results could be seen in Table 1.This study showed high variability of aluminium

concentrations and no correlation between aluminiumlevels and kind of package.

The medium of the aluminium content obtained forthe TNP solutions was in the medium range of otherstudies published before [5,7].

For their individual components, 10% calciumgluconat and 1M monopotasic phosphate, were themost contaminated, as well as the 1M sodium bicarbo-nate (another solution used frequently in nutrition fornewborn children).

The great variability found in the aluminium contentof solutions of different batches suggests that contam-

ination occurs during the manufacturing or storageprocesses in glass containers, although this can beavoided using the adequate control procedures.

In 1990, the FDA established an upper lever for theTPN of 25 mg/L and in 1998 recommended the inclusionof the aluminium content in the solutions tickets [8].

At present, our results showed that the levels arehighest than the not mandatory FDA guide and moreprofessional efforts, investigations and renewed infor-mation is necessary to resolve the problem.

We recommend reduction of caducity of somecomponents to avoid many months periods of storagein the critical care units.

References

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