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Abnormal trace elements in a patient on total parenteral nutrition with normal renal function
F Y Leung1, D M Grace, M A Alfieri
1Department of Laboratory Medicine, University Hospital, London, Ontario, Canada.
Clinical Biochemistry
|June 1, 1995
Summary
Total parenteral nutrition (TPN) can lead to toxic accumulation of trace metals like chromium and aluminum. Regular monitoring and adjusting nutrient solutions are crucial for patients on TPN.
Area of Science:
- Clinical Nutrition
- Trace Element Metabolism
- Parenteral Nutrition
Background:
- Total parenteral nutrition (TPN) is a life-sustaining therapy for patients with gastrointestinal dysfunction.
- Long-term TPN requires careful management of nutrient balance and potential toxicities.
- Mesenteric fibrosis and small bowel fistula present complex nutritional challenges.
Observation:
- A 74-year-old male on long-term TPN exhibited significant alterations in trace metal levels.
- Elevated serum chromium and plasma aluminum, with low serum selenium, were observed.
- Normal renal function did not prevent aluminum accumulation.
Findings:
- Serum chromium exceeded the upper reference range by over 21-fold.
- Serum selenium levels were less than half the lower reference range.
- Plasma aluminum was nearly double the upper reference range, despite normal renal function.
Implications:
- Parenteral nutrient solutions require rigorous monitoring for contaminants like aluminum and chromium.
- Adjusting calcium salts (e.g., chloride over gluconate) can reduce aluminum load.
- Individualized trace element management and contaminant surveillance are vital in long-term TPN.