Aluminum balance in intensive care patients

Aluminum (Al) is a well known contaminant of intravenous solutions. The aim of the present study was the estimation of the aluminum load in patients o f an intensive care unit (ICU). 15 patients with normal renal function took part. The study period was 15 days. Al was measured in serum, 24h-urine an d 132 samples of parenterals. Daily Al doses were recorded. Al balance was calculated on the basis of the iatrogenic Al dose and renal Al excretion. A l analysis was performed by graphite furnace atomic absorption spectrometry (AAS) with Zeeman background correction under careful quality control. sol utions with Al levels > 100 mug/l were: calcium salts, additives for parent eral nutrition solutions, antibiotics, acetylcysteine, triflupromazine, cat echolamines and colloids. The Al content of solutions for parenteral nutrit ion ranged from 4.3 to 69 mug/l. Al doses amounted to 46 - 456 (median 119) mug/d, equivalent to 0.7 to 6.5 (median 1.7) mug/kg b.w. RenalAl excretion ranged from 10.5 to 723.1 mug/d (median 53 mug/d). These amounts partly ex ceeded the maximal dose (2 mug/kg b.w. per day), recommended by ASPEN/ASCN. Despite of the highly elevated renal Al excretion the median serum concent ration of Al was only moderately increased (6.1 mug/l; range: <1.5 to 23.6 mug/l). However, calculations on the basis of the iatrogenic Al dose and re nalAl excretion resulted in a netAl uptake (median) of 61 mug/d (maximum: 2 91 mug/d). Al amounts of this magnitude must be considered potentially harm ful in ICU patients, especially with impaired renal function. Parenteral th erapy resulted in a considerable Al dose with a positive Al balance in ICU patients. Threshold values for Al contamination of parenterally administere d drugs and solutions should be established.