Abstract

Parenteral nutrition (PN) became an established hospital pharmacy in the 1960s. Some of the early patients on long-term PN developed micronutrient deficiency syn-dromes, emphasizing the importance of a complete nutri-tional formula. Trace elements currently considered es-sential for humans are the metals, copper, chromium, iron, manganese, molybdenum, zinc, and the metalloid selenium. Supplementation of PN regimens with trace ele-ments is now mandatory. Interactions between micro-nutrients 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 in-dividual trace elements, where symptoms of toxicity of one element can often be attributed to the resulting defi-ciency of another, due to enhanced excretion of that metal. Routine measurement of most trace elements is not essential in short-term PN. However, careful ob-servation and monitoring of trace element levels is im-portant 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 im-portant to determination of any additional micronutrient requirements. Contamination of PN products with sig-nificant amounts of trace elements and absorption to con-tainer surfaces can significantly affect actual dosage, with clinical repercussions over time. Therefore, in 2009, American Society for Parenteral and Enteral Nutrition con-cluded that changes were needed in the recommenda-tions 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. (J Korean Soc Parenter Enter Nutr 2013;5(3):102-109)

• Keywords: Trace elements, Parenteral nutrition, Conta-mination, Chromium, Manganese, Selenium