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Nutrition in Clinical Practice
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Teaching Case; Aluminum: A Problem Trace Metal in Nutrition Support

Anne Davis, MS, RD, CNSD

Biomedical Housecall Infusion Services, Inc., Raleigh, North Carolina

Ray Spillane, RPh

Biomedical Housecall Infusion Services, Inc., Raleigh, North Carolina

Lise Zublena, RD

Biomedical Housecall Infusion Services, Inc., Raleigh, North Carolina

ABSTRACT Aluminum contaminates both enteral and parenteral nutrients. Contamination depends on the amount of aluminum present naturally in chemicals or from the manufacturing process. Enteral nutrients such as soy formula, preterm infant formula, and casein hydrolysate formula that are highly processed are heavily contaminated with aluminum. Intravenous calcium, phosphorus, and albumin solutions have high aluminum content (>500 mcg/L). The kidney is the dominant organ for aluminum excretion. Even with normal renal function, only 307%-60% of an aluminum load from parenteral nutrition is excreted in the urine, resulting in tissue accumulation of aluminum. The risk for toxicity is greatest in infants with chronic renal insufficiency and long-term pediatric parenteral nutrition patients. Rapid growth in the infant can theoretically potentiate aluminum toxicity in all infants. The critical level of aluminum loading that results in bone disorders is not known. To minimize tissue accumulation, aluminum content of parenteral and enteral nutrients for infants and children should be reduced.

Nutrition in Clinical Practice, Vol. 14, No. 5, 227-231 (1999)
DOI: 10.1177/088453369901400503
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