The role of aluminum in parenteral nutrition associated cholestasis in infants and piglets

Abstract

Aluminum is a known contaminant of parenteral nutrition (PN) solutions and it has been suspected to play a role in the development of parenteral nutrition associated cholestasis (PNAC). The primary purpose of my research was to monitor the relationship between serum aluminum level and the development of PNAC in the infants with gastrointestinal failure who required PN therapy. The secondary purpose was to develop a neonatal piglet model to compare different doses of aluminum or PN therapy with known aluminum level was associated with the development of PNAC. Sixteen infants with gastrointestinal pathology were enrolled in the study. Serum aluminum and bilirubin (direct and indirect) concentrations were determined on day 0, 7, 14, and 21 of PN therapy. Five of sixteen (31.3%) infants developed PNAC by day 21. Serum aluminum levels in infants receiving PN peaked at day 7 of therapy and declined thereafter. There was no direct correlation between serum direct bilirubin and serum aluminum levels. Twenty-four piglets, 2 to 4 days old, were placed into four groups: Control group (n=5); Low Al (aluminum) group (n=7), intravenous (iv) injection with aluminum dose at 20 ìg•kg-1•day-1; High Al (aluminum) group (n=6), iv with aluminum dose at 1500 ìg•kg-1•day-1; PN (parenteral nutrition) group (n=6), PN solutions with a mean aluminum intake at 37.8±14.3 ìg•kg-1•day-1. The experiment period was 21 days. Serum bilirubin was significantly (p