scholarly journals Trace Element Provision in Parenteral Nutrition in Children: One Size Does Not Fit All

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1819 ◽  
Author(s):  
Boutaina Zemrani ◽  
Zoe McCallum ◽  
Julie Bines
Keyword(s):  
Trace Elements ◽  
Parenteral Nutrition ◽  
Trace Element ◽  
Clinical Condition ◽  
Standard Of Care ◽  
Current Evidence ◽  
Preterm Neonates ◽  
Global Consensus ◽  
Routine Administration

Routine administration of trace elements is recognised as a standard of care in children requiring parenteral nutrition. However, there is a lack of global consensus regarding trace elements provision and dosing in pediatric parenteral nutrition. This review provides an overview of available evidence regarding trace elements supply and posology in parenteral nutrition in neonates and children. Trace elements provision in children should be tailored to the weight and clinical condition of the child with emphasis on those at risk of toxicity or deficiency. Based on current evidence, there is a need to review the formulation of commercial solutions that contain multiple-trace elements and to enable individual trace elements additives to be available for specific indications. Literature supports the removal of chromium provision whereas manganese and molybdenum supplementation are debated. Preterm neonates may have higher parenteral requirements in iodine, selenium and copper than previously recommended. There is growing support for the routine provision of iron in long-term parenteral nutrition. Further studies on trace elements contamination of parenteral nutrition solutions are needed for a range of trace elements.

Trace Element Deficiencies during Total Parenteral Nutrition

1977 ◽  
Vol 11 (9) ◽  
pp. 536-541 ◽  
Author(s):  
Robert Lee Hull ◽  
Dennis Cassidy
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Parenteral Nutrition ◽  
Trace Element ◽  
Total Parenteral Nutrition ◽  
Therapeutic Agent ◽  
Copper Deficiency ◽  
Diagnostic Features ◽  
Case Presentation

The diagnostic features of copper deficiency are discussed, and a case presentation is compared with other reports in the literature. The need for copper supplement is stressed when total parenteral nutrition (TPN) is given to patients whose gastrointestinal tract is either shortened or incapable of reabsorbing copper. Since copper is recycled through the small bowel by way of the bile, any dysfunction of this area can lead to copper deficiency during TPN if inadequate amounts of copper are added to the basic TPN solutions. It is suggested that Dr. Shils' formula be used twice weekly for prophylaxis during long-term hyperalimentation and daily as a therapeutic agent when a deficiency is diagnosed.

Trace Element Status (Zinc, Copper, Selenium, Iron, Manganese) in Patients with Long-Term Home Parenteral Nutrition

2016 ◽  
Vol 69 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Milan Dastych Jr. ◽  
Michal Šenkyřík ◽  
Milan Dastych ◽  
František Novák ◽  
Petr Wohl ◽  
...  
Keyword(s):  
Trace Elements ◽  
Parenteral Nutrition ◽  
Blood Plasma ◽  
Whole Blood ◽  
Statistical Significance ◽  
Home Parenteral Nutrition ◽  
Control Group ◽  
The Status ◽  
In Blood Plasma

Background: The objective of the present study was to determine concentrations of zinc (Zn), copper (Cu), iron (Fe), selenium (Se) in blood plasma and manganese (Mn) in the whole blood in patients with long-term home parenteral nutrition (HPN) in comparison to the control group. Patients and Methods: We examined 68 patients (16 men and 52 women) aged from 28 to 68 years on a long-term HPN lasting from 4 to 96 months. The short bowel syndrome was an indication for HPN. The daily doses of Zn, Cu, Fe, Se and Mn in the last 3 months were determined. Results: No significant differences in blood plasma were found for Zn, Cu and Fe in patients with HPN and in the control group (p > 0.05). The concentration of Mn in whole blood was significantly increased in HPN patients (p < 0.0001), while Se concentration in these patients was significantly decreased (p < 0.005). The concentration of Mn in the whole blood of 16 patients with cholestasis was significantly increased compared to the patients without cholestasis (p < 0.001). The Cu concentration was increased with no statistical significance. Conclusion: In long-term HPN, the status of trace elements in the patients has to be continually monitored and the daily substitution doses of these elements have to be flexibly adjusted. Dosing schedule needs to be adjusted especially in cases of cholestatic hepatopathy. A discussion about the optimal daily dose of Mn in patients on HPN is appropriate. For clinical practice, the availability of a substitution mixture of trace elements lacking Mn would be advantageous.

Trace Element Concentrations in Commercially Available Solutions

1976 ◽  
Vol 10 (2) ◽  
pp. 74-76 ◽  
Author(s):  
Richard P. Hoffmann ◽  
Daniel M. Ashby
Keyword(s):  
Trace Elements ◽  
Trace Element ◽  
Atomic Absorption ◽  
Term Therapy ◽  
Intravenous Hyperalimentation ◽  
Element Concentrations ◽  
Copper And Zinc ◽  
Long Term Therapy

The use of trace-elements in intravenous hyperalimentation solutions has been recommended for long-term therapy. Very little information is available concerning the presence of these nutrients as contaminants in commercially available solutions. In view of this, the concentrations of copper and zinc were measured in twenty solutions by atomic absorption. The results indicate that the amounts present may be significant in certain solutions.

scholarly journals Stability of N-Acetylcysteine (NAC) in Standardized Pediatric Parenteral Nutrition and Evaluation of N,N-Diacetylcystine (DAC) Formation

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1849
Author(s):  
Isabelle Sommer ◽  
Hervé Schwebel ◽  
Vincent Adamo ◽  
Pascal Bonnabry ◽  
Lucie Bouchoud ◽  
...  
Keyword(s):  
Amino Acid ◽  
Parenteral Nutrition ◽  
Oxidation Process ◽  
Preterm Neonates ◽  
Dual Chamber ◽  
Long Term Storage ◽  
O2 Concentration ◽  
Term Storage

The ESPGHAN/ESPEN/ESPR-Guidelines on pediatric parenteral nutrition (PPN) recommend the administration of the semiessential amino acid (AA) cysteine to preterm neonates due to their biochemical immaturity resulting in an inability to sufficiently synthetize endogenous cysteine. The soluble precursor N-acetylcysteine (NAC) is easily converted into bioavailable cysteine. Its dimer N,N-diacetylcystine (DAC) is almost unconvertable to cysteine when given intravenously resulting in a diminished bioavailability of cysteine. This study aims to understand the triggers and oxidation process of NAC to DAC to evaluate possibilities of reducing DAC formation in standardized PPN. Therefore, different air volumes (21% O2) were injected into the AA compartment of a standardized dual-chamber PPN. O2 concentrations were measured in the AA solution and the headspaces of the primary and secondary packaging. NAC and DAC concentrations were analyzed simultaneously. The analysis showed that O2 is principally delivered from the primary headspace. NAC oxidation exclusively delivers DAC, depending on the O2 amount in the solution and the headspaces. The reaction of NAC to DAC being containable by limiting the O2 concentration, the primary headspace must be minimized during manufacturing, and oxygen absorbers must be added into the secondary packaging for a long-term storage of semipermeable containers.

scholarly journals Balance study of twenty trace elements during total parenteral nutrition in man

1977 ◽  
Vol 37 (1) ◽  
pp. 107-126 ◽  
Author(s):  
S. Jacobson ◽  
P.-O. Wester
Keyword(s):  
Trace Elements ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Cobalt Chromium ◽  
Fat Emulsion ◽  
Balance Study ◽  
Directional Change ◽  
Male Patients ◽  
Exchange Technique

1. Balances of twenty trace elements (silver, arsenic, gold, bromine, cadmium, cobalt, chromium, caesium, copper, iron, mercury, lanthanum, molybdenum, rubidium, antimony, scandium, selenium, samarium, tungsten and zinc) have been determined in four male patients during total parenteral nutrition including fat emulsion and a special solution for addition of Fe, Zn, manganese, Cu, fluorine and iodine, besides calcium and magnesium, to the infusion solutions.2. The analyses for trace elements were made with the aid of an ion-exchange technique based on neutron activation, and combined with subsequent gamma spectrometry.3. The intended intravenous supply of trace elements corresponded approximately to the analysed supply. However, all the other trace elements determined were found to be unintentionally administered in small amounts.4. There was a substantial retention of Fe. Other elements retained were Ag, Co, Cr, Cu, Sb, Sc and W.5. Particularly Br and Rb were lost by the patients, but negative balances were also found for As, Au, Cd, Cs, Mo, Se and Zn. However, Zn was retained by one patient with short bowel syndrome.6. The serum concentrations of thirteen (Ag, Br, Co, Cs, Cu, Fe, Hg, Mo, Rb, Sc, Se, W and Zn) of the trace elements were found to have some decrease during the period of total parenteral nutrition, mostly in accordance with the corresponding balance values. Fe, in particular, was found to have the directional change in concentration.7. The administration of trace elements is recommended in long-term total parenteral nutrition.

scholarly journals Current Evidence for the Use of Smoflipid® Emulsion in Critical Care Patients for Parenteral Nutrition

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Alberto A. Leguina-Ruzzi ◽  
Rina Ortiz
Keyword(s):  
Parenteral Nutrition ◽  
Positive Impact ◽  
Hospital Length ◽  
Current Evidence ◽  
Structural Function ◽  
Energy Needs ◽  
Total Treatment ◽  
Anti Inflammatory ◽  
Body Energy

There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20–50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient’s physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function. However, these patients also require a mixture of essential and nonessential fatty acids (SMOF emulsions) to supply not only energy needs but also restore immunological, anti-inflammatory, and proregenerative functions. A revision of the safety and efficacy of Smoflipid® in patients requiring long-term parenteral nutrition was discussed here. Although controversial data are available indicating the contraindications or effectiveness of its use, most of studies presented indicate favorable benefits associated with improved clinical outcomes. The reported roles of this supplementation include positive immunomodulatory and anti-inflammatory effects, positive impact in liver function, reduction of hospital stay, and nosocomial infections as additional contributions to its energetic role, which in many cases results in reduced total costs per patient. Finally, many authors propose that the use of Smoflipid® should become a gold standard of parenteral nutrition in intensive unit care patients and that the costs associated with this supplement should not be limiting for its use, not only to improve the clinical outcome but also to reduce the treatment costs.

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