title: Plasma Aluminum Concentrations in Pediatric Patients Receiving Long-Term Parenteral Nutrition.
abstract: BACKGROUND
  Patients receiving long-term parenteral nutrition (PN) are at increased risk of aluminium (Al) toxicity because of bypass of the gastrointestinal tract during PN infusion. Complications of Al toxicity include metabolic bone disease (MBD), Al-associated encephalopathy in adults, and impaired neurological development in preterm infants. Unlike the United States, there are no regulations regarding Al content of large- and small-volume parenterals in Canada. We, therefore, aimed to present our data on plasma Al concentration and Al intake from our cohort of pediatric patients receiving long-term PN.
  
  
  METHODS
  Plasma Al concentration was retrospectively gathered from the patient charts of all 27 patients with intestinal failure (IF) receiving long-term PN at The Hospital for Sick Children, Toronto, Canada, and compared with age- and sex-matched controls recruited for comparison. In addition, Al concentration was measured in PN samples collected from 10 randomly selected patients with IF and used to determine their Al intake.
  
  
  RESULTS
  The plasma Al concentration of patients with IF receiving long-term PN was significantly higher than that of control participants (1195 ± 710 vs 142 ± 63 nmol/L; P < .0001). In the subgroup of 10 patients for whom Al intake from their PN solution was determined, mean ± SD Al intake from PN was 15.4 ± 15 µg/kg, 3 times the Food and Drug Administration upper recommended intake level, and Al intake was significantly related to plasma Al concentration (P = .02, r (2) = 0.52).
  
  
  CONCLUSIONS
  Pediatric patients receiving long-term PN for IF in Canada are at risk for Al toxicity.
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada glenda.courtney-martin@sickkids.ca.
authors.forename: Glenda
authors.initials: G
authors.lastname: Courtney-Martin
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Kosar
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Campbell
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Steinberg
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Harrison
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chambers
mesh_terms: D000293:Adolescent; D000328:Adult; D000535:Aluminum / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology*; D001927:Brain Diseases / Q000097:blood / Q000209:etiology*; D002170:Canada; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004340:Drug Contamination / Q000331:legislation & jurisprudence; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D065886:Neurodevelopmental Disorders / Q000097:blood / Q000209:etiology*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects* / Q000737:chemistry; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D012189:Retrospective Studies; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D057947:Parenteral Nutrition Solutions; D000535:Aluminum
keywords: life cycle; minerals/trace elements; nutrition; parenteral nutrition; pediatrics