Serum Levels of 1,25-Dihydroxyvitamin D in Children Receiving Parenteral Nutrition with Reduced Aluminum Content

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Abstract
Both adults and children receiving total parenteral nutrition (TPN) have been found to have low serum levels of 1,25(OH)2-vitamin D [1,25(OH)2D]. Many of these were subsequently found to have inadvertently received large quantities of aluminum in the TPN solution. Since aluminum administration to dogs is associated with a fall in serum 1,25(OH)2D levels, the present study was designed to prospectively follow serum levels of this sterol while patients received a TPN solution low in aluminum. Nine children received a TPN solution comparable to that previously administered to children who demonstrated low serum levels of 1,25(OH)2D, except for a moderately reduced phosphorus and markedly reduced aluminum content. Serum was obtained during the first and fourth weeks of TPN treatment and analyzed for 1,25(OH)2D, 25-hydroxyvitamin D [25(OH)D], immuno-reactive parathyroid hormone (iPTH), calcium, and phosphorus. Results revealed normal or high serum levels of 1,25(OH)2D and normal levels of iPTH, calcium, phosphorus, and 25(OH)D. Thus, low aluminum-containing TPN does not produce a fall in serum 1,25(OH)2D, providing evidence that aluminum may have been a factor in causing the reduced serum 1,25(OH)2D in those children previously receiving TPN.