Parenteral trace element provision: recent clinical research and practical conclusions

Stehle, Peter; Stoffel‐Wagner, Birgit; Kuhn, Katharina S.

doi:10.1038/ejcn.2016.53

Cited by 48 publications

(40 citation statements)

References 106 publications

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“…Currently, there is no consensus on the utility of cerebral MRI in monitoring patients treated with PN. Authors have recommended MRI for monitoring Mn accumulation in patients who have liver dysfunction or are receiving long‐term PN . Others have stated that MRI may be appropriate if toxicity is suspected .…”

Section: Practical Considerationsmentioning

confidence: 99%

“…Authors have recommended MRI for monitoring Mn accumulation in patients who have liver dysfunction or are receiving longterm PN. 16,162 Others have stated that MRI may be appropriate if toxicity is suspected. 149,160 In my opinion, MRI is appropriate in patients who have neurologic symptoms, the cause of which is uncertain or which fail to resolve after Mn is withheld.…”

Section: Monitoring Of Mn Status During Pnmentioning

confidence: 99%

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Manganese Provision in Parenteral Nutrition: An Update

Livingstone

2017

Nut in Clin Prac

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Manganese (Mn) is an essential micronutrient required for the activity of metalloenzymes. It is an essential component of parenteral nutrition (PN), but requirements are low. Mn status is difficult to assess, with the commonest method being measurement of its concentration in whole blood. This method has limitations, including artifactually high concentrations resulting from contamination of specimen tubes. Mn toxicity is a well-recognized complication of PN, the risk of which increases if there is cholestasis or if the patient has received high doses. It usually presents with parkinsonian-like symptoms but may be detected presymptomatically as hypermanganesemia or as increased signal intensity of the basal ganglia upon T1-weighted magnetic resonance imaging. Caution is necessary when providing Mn for patients on long-term PN (>1 month). It is advisable to withhold supplementation if hypermanganesemia or cholestasis develops. Deficiency of Mn is rare in patients treated with PN. PN regimens are contaminated with Mn in amounts likely to meet requirements. Consequently, it is debated whether PN should be routinely supplemented with Mn. The currently recommended dose of Mn in adults treated with PN is 55 μg/d, but the doses provided by most currently available multi-trace element products exceed this. In response to calls for new products to be developed, 2 new multi-trace element products are currently available in Europe that provide Mn doses of 55 μg/d. Once these products are in general use, it is likely that the incidence of Mn toxicity will decrease.

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Section: Practical Considerationsmentioning

confidence: 99%

Section: Monitoring Of Mn Status During Pnmentioning

confidence: 99%

Manganese Provision in Parenteral Nutrition: An Update

Livingstone

2017

Nut in Clin Prac

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“…The European Society for Clinical Nutrition and Metabolism (ESPEN) made the same recommendation in its guidance on perioperative PN 114 . These recommendations were supported by a recently published systematic review of TE supplementation in PN 115 …”

Section: Practical Considerationsmentioning

confidence: 97%

Review of Copper Provision in the Parenteral Nutrition of Adults

Livingstone

2016

Nut in Clin Prac

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ReviewCopper (Cu) is an essential trace element (TE) required for metabolism in all living cells. It has been known to be an essential component of parenteral nutrition (PN) since 1972.1 Provision of the correct amount of Cu is necessary, not only to avoid deficiency and toxicity, but also to promote optimal recovery.2 This article covers the relevant physiology of Cu. It then discusses Cu deficiency and toxicity and examines the evidence behind the recommendations on Cu provision in PN. It provides practical guidance on assessment of Cu status and Cu requirements. The article focuses on adults because provision of Cu in pediatric PN has recently been covered elsewhere, 3 but pediatric studies have been cited where considered appropriate. PhysiologyCu is among the 3 most abundant transition metals in biological systems, the other 2 being iron (Fe) and zinc (Zn). The human body contains around 100 mg of Cu, more than half of which is in bone and muscle. The highest concentrations are in liver, kidney, and brain, reflecting the high metabolic activity of these organs.2 Only 5% is in blood, about 95% of this being bound to ceruloplasmin (Cp) and the remainder to albumin and amino acids. 4 The serum Cu concentration therefore largely reflects the Cp concentration and is affected by factors influencing Cp. Intracellular Cu is usually bound to chaperones and other proteins because free Cu is potentially harmful to cells.Cu, which functions as a component of cuproproteins, has a variety of physiologic roles. For example, it is required for humoral immunity and production of inflammatory cytokines. 5,6 It was recently suggested that the immune system uses Cu intoxication as a means of intracellular bacterial killing. 7,8 Cu is required for the physiologic response to low Fe stores. It is needed for absorption of dietary Fe, release of Fe from hepatocytes and production of hemoglobin.9 Cp oxidizes Fe from the ferrous to ferric state, enabling its transport by transferrin and subsequent use in erythropoiesis. Superoxide dismutase is an antioxidant cuproenzyme that catalyzes the conversion of superoxide radicals to hydrogen peroxide, which is then reduced to water.10 Cu is also necessary for wound healing because it is required for the synthesis of collagen.The average daily oral intake of Cu is 1.0-1.6 mg, which exceeds the RDA of 0.9 mg.11 Dietary Cu is absorbed mainly in the stomach and upper small intestine.2,12 About 55%-75% of dietary Cu is absorbed, which is a high proportion as compared AbstractThe essential trace element copper (Cu) is required for a range of physiologic processes, including wound healing and functioning of the immune system. The correct amount of Cu must be provided in parenteral nutrition (PN) if deficiency and toxicity are to be avoided. While provision in line with the standard recommendations should suffice for most patients, Cu requirements may be higher in patients with increased gastrointestinal losses and severe burns and lower in those with cholestasis. The tests of Cu status that are c...

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“…Therefore, all PN prescription should include a physiological dose of trace elements to prevent imbalances and deficiencies. Prolonged PN therapy may be associated with the development of deficiency syndromes if adequate micronutrients are not supplied from the PN formulas 20 . Optimization of PN therapies is necessary by outcome assessment with regards to the formula we used 21 .…”

Section: Discussionmentioning

confidence: 99%

Parenteral nutrition therapy for neonates: Experience in a tertiary care centre in Sri Lanka

Wickramatilake

Withanaarachchi

Dharmadasa³

et al. 2018

Sri Lanka J Child Health

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Background: There is scarce literature about the practice of parenteral nutrition (PN) in neonates in Sri Lanka. Objectives:To describe the characteristics of neonates receiving PN, the current practice of PN and the complications developing in neonates receiving PN in Sri Lanka. Method:A descriptive cross-sectional study was conducted on babies receiving PN after admission to the Special Care Baby Unit of a Tertiary Care Centre in Sri Lanka during 2014. Data was gathered from mothers, medical records and by clinical examination of the babies.Results: Fifty six neonates were on PN during 2014. Twenty (36%) were on PN for 4 days. All babies were fed on breast milk as the trophic feeds except one who was given formula milk. Initiation of trophic feeds was early (median day 2). Fifty one (91%) were started on trophic feeds by day 3 with 14 (25%) on day 1. Twenty six (46%) developed complications consisting of septicaemia (5), hypoglycaemia (9), hyperglycaemia (2), hypernatraemia (23), catheter site related complications (4) and thrombocytopenia (7). Conclusions:The median duration of PN was 4 days. Trophic feeds with expressed breast milk were started in 91% by day three. Forty six percent of babies on PN developed complications. ________________________________________

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Parenteral trace element provision: recent clinical research and practical conclusions

Cited by 48 publications

References 106 publications

Manganese Provision in Parenteral Nutrition: An Update

Manganese Provision in Parenteral Nutrition: An Update

Review of Copper Provision in the Parenteral Nutrition of Adults

Parenteral nutrition therapy for neonates: Experience in a tertiary care centre in Sri Lanka

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