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Aluminum (Al) delivered to preterm infants via parenteral nutrition may exceed the limit of 5 µg/kg/day set by the US Food and Drug Administration. This study evaluated the effect of the administration of an equivalent amount of Al (0.12 mg/kg/day) to newborn rats. The study included the administration of a higher amount of Al (24.8 mg/kg/day) not only to newborn rats but also to adult (2- and 4-month-old) rats. Aluminum was intraperitoneally administered for a period of 10 days. Newborn animals were evaluated for developmental changes every day starting from the second day after birth. Twenty days after the last administration, 10 animals were killed and their organs were removed; the remainders were killed on day 40. A dosage of 24.8 mg/kg/day was administered to the two groups of adult rats, which were killed following the same protocol after 20 and 40 days. The results of physical parameters and developmental and behavioral tests were not conclusive and no significant differences were observed between the lower and higher Al dose and control groups. The group that received 0.12 mg/kg/day showed significant differences in Al accumulation only in the liver and muscle. The groups that received a higher dose of Al showed an accumulation in all tissues among all age groups studied, but the newborn group showed the greatest accumulation (results for day 20). After 40 days, Al content in all tissues decreased more than 50% in this group, whereas among the adults, the Al content increased or remained constant. An increase in age correlated with a lower elimination rate. Considering the ongoing human Al exposure, along with its age-related elimination rate, Al accumulation in the body may be long-lasting.

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Preterm neonates receiving parenteral nutrition are at risk of aluminum (Al) overload because of the presence of Al as a contaminant in parenteral formulations. Despite US Food and Drug Administration regulation, commercial products continue to present Al contamination. To reassess Al exposure in the premature neonatal population, the present study evaluated the Al balance (intake vs urinary excretion) in a group of preterm neonates during the period in which they stayed in the intensive care unit (NICU) under total parenteral nutrition. For the 10 patients selected, daily infusion solutions (nutrition and medication) were collected and the level of Al contamination was measured. From the urine collected daily, an aliquot was taken for Al determination. Blood was also collected for Al determination on the first and last day in the NICU. The measurements were carried out by atomic absorption spectrometry. The difference between Al administered and excreted revealed that 56.2% +/- 22.7% of the Al intake was not eliminated. The mean serum Al levels from the first to the last day decreased from 41.2 +/- 23.3 to 23.5 +/- 11.2 microg/L. The resulting mean Al daily intake of the 10 patients was 15.2 +/- 8.0 microg x kg(-1) x day(-1). Because Al intake was higher than that excreted and Al in serum decreased to practically half during the period in the NICU (+/-7.3 days), some amount of Al deposition occurred. Moreover, premature neonates were receiving, on average, 3 times the amount of 5 microg x kg(-1) x day(-1), considered by the Food and Drug Administration as a safe limit.

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BACKGROUND: Although dialysis facilities provide high-quality water, abnormal aluminium levels among patients on haemodialysis have still been reported. Since patients with chronic kidney disease are often on multiple medications, medicines may be an extra source of aluminium for them. The degree to which ingesting contaminated medication influenced the level of aluminium in the patients' blood was investigated. METHODS: All medications consumed by a group of patients on regular dialysis treatment were analysed and the total aluminium ingested by each patient was calculated. At the same time, the patients' blood was collected and aluminium was measured. The analyses were carried out by atomic absorption spectrometry. RESULTS: For all drugs consumed, the amount of aluminium ingested versus the blood aluminium level presented no correlation. Since a high level of contamination was presented by injectable iron, insulin and erythropoietin (EPO), another group of patients that received a reduced amount of oral medication was selected. Among them, eight did not receive any injectable drug, five received only EPO and seven injectable iron, EPO and insulin. With these restricted groups, it was possible to show that the injectable administration of contaminated medication increased the Al level in the patients' blood, mainly in relation to iron formulations. CONCLUSION: Among the medications investigated, the injectables are the most significant source of aluminium for patients with renal insufficiency. This extra aluminium intake is reflected in higher aluminium levels in the patients' blood.

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Objetivo: O alumínio é muito comum na natureza e pode se acumular nos pacientes com insuficiência renal terminal em tratamento dialítico. É necessário,neste grupo de pacientes, a monitorização sérica e identificação de toxicidade, especialmente óssea. Este trabalho descreve a pesquisa realizada junto apacientes com insuficiência renal crônica, submetidos a tratamento dialítico na Casa de Saúde de Santa Maria, RS, com a finalidade de verificar se háinfluência da água e de alimentos ingeridos pelos pacientes nos níveis de alumínio sérico. Pacientes e Métodos: Os pacientes responderam a um questionáriosobre hábitos alimentares e, de acordo com as respostas, os alimentos de uso mais freqüente foram selecionados e analisados para a quantificaçãodo alumínio. Amostras da água utilizadas em suas residências e de sangue dos pacientes foram coletadas para quantificar o alumínio. O alumíniofoi dosado por espectrometria de absorção atômica. Para avaliar a quantidade de alumínio ingerida através dos alimentos padronizou-se o consumo atravésde porções básicas convertidas em massa. A partir deste cálculo foi possível determinar o alumínio ingerido por dia, por cada paciente em função dos alimentosconsumidos. Para a água considerou-se o consumo diário de 1 litro e, portanto, a ingestão da quantidade de alumínio contida neste volume. Umtotal de 133 pacientes participou do estudo, 82 amostras de água tratada, de poço artesiano e mineral foram analisadas, provenientes de Santa Maria, RSe outras cidades da região. Foram analisados 27 tipos de alimentos incluindo grãos, frutas, verduras, bebidas, pão e açúcar. Resultados: As amostras deágua apresentaram níveis de alumínio entre 3 e 439µg/L, considerando as três fontes mencionadas. Entre os alimentos, os maiores níveis foram encontradosno arroz, 92µg/g, na alface, 48µg/g, e no leite, 1700µg/L. Sucos artificiais e refrigerantes também apresentaram níveis elevados de alumínio, entre60 e 257µg/L. Conclusões: Não foi observada relação entre os níveis de alumínio sérico e o nível de alumínio presente nas águas ingeridas pelospacientes, porém foi encontrada relação entre o nível de alumínio e a concentração em alguns alimentos.

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A elevada toxicidade do alumínio para pacientes com insuficiência renal está muito bem documentada na literatura. A ação tóxica deste elemento é tão elevada que um controle anual dos níveis de alumínio sérico dos pacientes submetidos regularmente ao tratamento de hemodiálise é exigida pela Agência Nacional de Vigilância Sanitária (ANVISA). Devido à ubiquidade do aluminio, a análise requer cuidados especiais com relação à contaminação. Neste trabalho são abordados os aspectos mais importantes, desde a coleta até a quantificação do alumínio propriamente dita, para evitar fontes externas de contaminação e conduzir análise com êxito. Os cuidados necessários tornam-se relevantes devido ao baixo limite que coloca o paciente em risco. Níveis de Al acima de 30ug/L já caracterizam intoxicação, e determinam tratamento com agente quelante para redução do nível de Al sérico. Como este tratamento não é isento de efeitos colaterais, é muito importante que resultados confiáveis seja obtidos na análise do alumínio sérico.

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