Trace metal abnormalities in adults during hyperalimentation

Trace metal deficiencies are now a well-documented complication of total parenteral nutrition (TPN). Zinc deficiency may present in a variety of ways including acrodermatitis skin lesions, impaired immunity, poor growth or impaired wound healing, and mental disturbances. Copper deficiency presents a more uniform picture of hematologic abnormalities, usually anemia with leukopenia and neutropenia. Chromium and selenium deficiencies occur much less frequently, but well-documented cases have been reported. We currently recommended regular monitoring and supplementation of these four trace metals during TPN administration. This article describes the clinical abnormalities that may develop when deficiencies of trace metals occur during TPN administration, and we present recommendations for trace metal supplementation during TPN administration.