This is very interesting, actually knowing the aluminium content in the different source ingredients, allows auto-calculation of aluminium in final PN bag (utilizing auto compounders’ software). Knowing its toxicities, aluminium should be kept below a defined minimum for the patient population you serve, like stated in study attached by Mohammed, especially for the neonate patient.
The study also points at FDA mandating manufacturers to state that the aluminium content is less than 25 mcg/L in LVP and state the aluminium content in their SVP product’s package insert. We tried to find this information in the products we have here, but none was found even after contacting the local agent.
This topic is getting famous and important and I think the only accurate way is to perform a quick investigation at our hospitals for the content we use individually and precisely. I think hospital Lab can do it, as long as they have the mechanism to measure trace elements in blood, I think they can do it for TPN contents.
This is very useful indeed. I’ll include the items that we have from the list you referred, and ask if average aluminium content per product can be checked by our labs. My understanding is the concentration increases with time and peaks near expiry date of product, will this have a significant effect on the results get from our lab in case that is possible?
Well, you are right, that was a pretty tough question. I don’t have an answer based on my experience, but I may try to do the next:
– Avoid using high Alu. content products as much as possible, and I think it is affordable to avoid using Sodium Phosphate vials (use Glycerophosphate instead), avoid using Potassium Phosphate Amp. except when there is no choice. Calcium Gluconate glass ampoules is replaced already in the market by plastic vials.
– Avoid using these drugs after one year of its production if you have to use them.
– Avoid combining more than one of these products together if you have to use them.
Meanwhile, if you have a plan to investigate the Alu. contents in your products, I think you can apply the next strategies:
– Take the average of Alu. contents after one year storage, 2 years, …etc.
– Use different Alu. contents for the same product; after one year storage, 2 years, and so on. This is very challenging to be fed on software, but I think it is doable.
– Use the maximum value of Alu. content for each product regardless to its storage time. It is not accurate enough but may be safer than using the averages.