ABNORMAL TRACE-ELEMENTS IN A PATIENT ON TOTAL PARENTERAL-NUTRITION WITH NORMAL RENAL-FUNCTION

Objective: To describe trace metal changes in a 74-year-old male patie nt with mesenteric fibrosis and a small bower fistula who was maintain ed on total parenteral nutrition in the hospital and at home. Methods: Trace elements which included chromium and selenium were monitored ov er a 14-month period as part of his nutrient follow-up. Results: Serum chromium reached levels >21-fold the upper reference range, and serum selenium, in contrast, was <0.5 the lower reference range. Plasma alu minum was also measured, and found to be nearly twice the upper refere nce range, although the patient had normal renal function. We measured the aluminum content of the parenteral nutrients and additives, and f ound that replacement of calcium gluconate by calcium chloride helped to reduce the aluminum content in the final parenteral solution by 34% . Aluminum and chromium contaminants found in parenteral solutions nee d to be reduced or removed to avoid toxic accumulation. Conclusion: Th is study illustrates the importance of adequately adjusting essential trace elements, and monitoring contaminants in parenteral fluids in an individual on total parenteral nutrition.