OBJECTIVE: The study objective was to reduce aluminum (Al) in Calcium Gluconate Injection, US Pharmacopeia (USP) used in the preparation of parenteral nutrition (PN) solutions.

METHODS: A flow-through filter containing an immobilized chelator that complexes Al from Calcium Gluconate Injection, USP as it flows through the filter was designed, refined by design modifications, and extensively tested. When a small-volume parenteral vial containing 100 mL of Calcium Gluconate Injection, USP is connected on the inlet side of the filter, and the outlet side is connected to an evacuated receiving vial, the filtered solution is drawn into the receiving vial. This constitutes a complete system to remove Al from Calcium Gluconate Injection, USP.

RESULTS: The extent of Al removal is flow rate dependent. At a flow rate of 1 mL/min approximately 85% of the Al was removed from calcium gluconate solution. PN solutions have been reported to deliver 15 to 23 mcg/kg/day Al to neonates. Given that Calcium Gluconate Injection, USP provides 85% of the Al in neonatal PN solutions, removal of 85% of the Al from this source was calculated to reduce Al delivered to most neonates to < 5 mcg/kg/day.

CONCLUSIONS: A point-of-use, self-contained, single-use, disposable, Al-complexing filter has been created. It was calculated to reduce Al delivered in PN solutions by 72%, resulting in daily Al delivery below the level that results in Al accumulation associated with central nervous system and bone toxicity to all but the smallest (< 1 kg) infants.

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Published in The Journal of Pediatric Pharmacology and Therapeutics, v. 19, no. 3, p. 189-195.

© 2014 Pediatric Pharmacy Advocacy Group.

The copyright holder has granted the permission for posting the article here and for downloading the article for single use by individuals.

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Funding Information

This work was supported by funds from the Thrasher Research Fund, the Kentucky Science and Engineering Foundation (KSEF-06-SBIR-059 and KSEF-148-504-09-107), the Kentucky Science and Technology Corporation (KSTC-06-COMM-006, KSTC-147-406-99, KSTC-184-512-08-04, and KSTC-184-512-11-106), and the National Institutes of Health (1R41HD055009 and 2R42HD055009-2).

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Robert A. Yokel has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.