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BRIANS. SMITH, PHARM.D., BCPS, is Director, Pharmacy Practice Residency, Clinical Pharmacy Specialist, Department of Critical Care Surgery, UMass Memorial Medical Center (UMMMC), Worcester, MA. HEMAKOTHARI, PHARM.D., is Pharmacy Practice Resident, New York Presbyterian Hospital, New York. BRYAND. HAYES, PHARM.D., is Pharmacy Practice Resident, UMMMC. GARYTATARONIS, M.S., is Associate Professor of Mathematics and Statistics, Massachusetts College of Pharmacy and Health Sciences, Boston. MARGARETHUDLIN, M.D., is Co-Director, Surgical Critical Care Services, UMMMC. JOHNDOOLE, PHARM.D., is Clinical Pharmacy Specialist, Nutrition Support and Quality Management, Boston Medical Center, Boston. CHRISTIANHARTMAN, PHARM.D., is Director, Patient Safety and Informatics Residency, and Manager, Medication Safety, UMMMC.

Address correspondence to Dr. Smith at the Department of Critical Care Surgery, UMass Memorial Medical Center, Worcester, MA 01655 (smithb02{at}ummhc.org).

Purpose. The quantity of aluminum in common ingredients used to compound parenteral nutrient (PN) solutions was calculated to quantify the actual aluminum content, and opportunities to modify the aluminum content by changing the manufacturer of the ingredients were explored. Methods. A retrospective evaluation of a random sample of 10 neonatal, 10 pediatric, and 10 adult patients who received PN solutions was performed to quantify the aluminum content in these solutions on the basis of the ingredients used at the authors’ institution. A recalculation was performed using the lowest aluminumcontaining ingredients to determine the potential for aluminum minimization in each PN solution. Results. Various manufacturers produce each ingredient required to make PN solutions. Significant variation exists among manufacturers, vial size, and concentrations. Statistically significant differences in the mean aluminum content of PN solutions before and after aluminum minimization were found to exist within each sample of patients. Among the neonatal PN solutions, aluminum content was significantly reduced from a mean ± S.D. of 84.16 ± 47.61 to 33.6 ± 16.69 µg/kg/day. The pediatric PN solutions had a significant decline in aluminum content from a mean ± S.D. of 16.24 ± 3.66 to 6.84 ± 2.66 µg/kg/day. Aluminum content in the high-risk adult PN solutions significantly decreased from a mean ± S.D. of 4.58 ± 2.06 to 2.31 ± 0.63 µg/kg/day. Conclusion. There is wide variability in the aluminum concentration of injectable products used in the compounding of PN solutions. Selecting products with low aluminum concentration may substantially reduce the amount of the element administered to patients. Index terms: Additives; Aluminum; Concentration; Contamination; Metals; Nutrition; Pediatrics

 

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