title: Recent developments in aluminium contamination of products used in parenteral nutrition.
abstract: OBJECTIVE
  This review evaluates recent developments concerning aluminium contamination of products used in the preparation of parenteral nutrition solutions and the failure of the pharmaceutical industry to respond to these concerns. The difficulty in meeting the intent of the recent US Food and Drug Administration mandate to reduce aluminium exposure with currently available parenteral nutrition additives is addressed. This review also summarizes the issues associated with aluminium toxicity, the patient populations at risk, treatment options, and compounding considerations.
  
  
  RESULTS
  Unfortunately, the published literature detailing the toxicities seen from aluminium exposure in the parenteral nutrition patient are primarily limited to those published in the 1980s and 1990s. Recent publications refer back to these classic papers and discuss the challenges that practitioners face when trying to apply the recommendations of the recently implemented Food and Drug Administration mandate with outdated literature. Few studies have been published to validate those earlier findings.
  
  
  CONCLUSIONS
  The issues surrounding aluminium toxicity are real and must be addressed. In order to make meaningful changes in clinical practice, low aluminium parenteral nutrition additives are needed and studies must be conducted using currently available products. It remains a challenge to optimize nutritional intake from parenteral nutrition and at the same time reduce aluminium exposure.
authors.affiliation: Department of Pharmacy, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. kathleen.gura@childrens.harvard.edu
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.forename: Mark
authors.initials: M
authors.lastname: Puder
mesh_terms: D000535:Aluminum / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D003257:Consumer Product Safety; D004340:Drug Contamination / Q000517:prevention & control; D006801:Humans; D010288:Parenteral Nutrition / Q000009:adverse effects; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000535:Aluminum