Practical Considerations in Trace Element Supplementation via Adult Parenteral Nutrition

Choi, Sooan

Abstract

Parenteral nutrition (PN) became an established hospital pharmacy in the 1960s. Some of the early patients on long-term PN developed micronutrient deficiency syndromes, emphasizing the importance of a complete nutritional formula. Trace elements currently considered essential for humans are the metals, copper, chromium, iron, manganese, molybdenum, zinc, and the metalloid selenium. Supplementation of PN regimens with trace elements is now mandatory. Interactions between micronutrients and macronutrients can affect their availability and the correct chemical balance must be attained for achievement of maximum stability, metabolic function, and clinical efficacy. A complex relation exists among individual trace elements, where symptoms of toxicity of one element can often be attributed to the resulting deficiency of another, due to enhanced excretion of that metal. Routine measurement of most trace elements is not essential in short-term PN. However, careful observation and monitoring of trace element levels is important in patients with renal or hepatic dysfunction, those on long-term PN, or when pharmacologic doses over the normal nutritional recommendations are given. Continual monitoring and reassessment of clinical symptoms is important to determination of any additional micronutrient requirements. Contamination of PN products with significant amounts of trace elements and absorption to container surfaces can significantly affect actual dosage, with clinical repercussions over time. Therefore, in 2009, American Society for Parenteral and Enteral Nutrition concluded that changes were needed in the recommendations for the daily requirements for these micronutrients in PN. In this review, I provide recent guidelines for the use of trace elements in nutrition therapy. This should be helpful to nutritional professionals in understanding the important role as a critical component, without negative outcome due to inadequate supplementation.