Aluminum in IV fluids hinders development

Are your pediatric patients at risk?

A recent study conducted by researchers at Shriners’ Hospital for Children in Montreal shows that IV fluids and the trace amounts of aluminum contained in such fluids may be harming the mental development of premature infants.1 The study, which took more than five years to complete, evaluated the mental development of 182 children at 18 months of age. The results found that the 90 children who had received standard IV fluids as premature infants were more likely to score lower than the 92 children who had received aluminum-depleted IV solution as premature infants.

"There’s almost certainly going to be a very, very small amount of aluminum in solutions," the study’s lead researcher, Nicholas J. Bishop, MD, tells Home Infusion Therapy Management. He is a visiting professor at Shriners’ Hospital for Children. Bishop adds that it is presently unclear where the aluminum is coming from.

"There are a couple of potential routes," notes Bishop. "First, it inadvertently gets in the solution during the manufacturing process, or during storage it may leak out of glass."

Bishop is quick to note that premature infants are much more prone to complications than your typical home infusion patient, but that’s not to say your own patients aren’t at risk.

"Premature infants are very sick, and renal function is very poor," he says. "The problem [with home infusion] is many patients are on home infusion for years, and there is obviously, therefore, a risk that the level of exposure, even if it is very low, will be cumulative. Having said that, I’m not aware of signs of aluminum toxicity appearing in that patient population. My guess would be it is excreted before being deposited in critical areas, and the majority of aluminum that gets into the body is excreted very quickly."

Some questions could remain unanswered

However, he’s quick to note that it may never be known how quickly such aluminum is excreted. There are two types of aluminum that could be used for such a test, but neither is practical.

"As far as I’m aware, nobody has done studies of intravenous aluminum and how fast it is excreted [in typical home infusion patients]," says Bishop. "Two types of aluminum could be used to do this as trace elements. One has a half-life of something like a half-million years, so you really don’t want that in your system. The other has a half-life measured in seconds. So, basically there is nothing you could use."

Because aluminum retention from IV solutions is therefore an unknown, Bishop recommends that home infusion agencies discuss with their solution provider whether the aluminum content has been measured.

"More mature individuals are more likely to be at a very low risk [than the premature infants in the study]," notes Bishop. "Having said that, to minimize the risk, one of your steps should be to contact the provider and ask them to reduce as far as possible any aluminum in solutions."

Reference

1. Bishop N, Morley R, Day J, et al., Aluminum Neurotoxicity in Preterm Infants Receiving Intravenous-Feeding Solutions, N Eng J Med, 1997; 336:1,557-1,561.