title: Neurologic symptoms due to possible chromium deficiency in long-term parenteral nutrition that closely mimic metronidazole-induced syndromes.
abstract: BACKGROUND
  We previously described a patient on home parenteral nutrition (HPN) who developed glucose intolerance and neuropathy that only responded to an infusion of chromium. A patient on HPN who had neuropathy and glucose intolerance was studied. He was also on metronidazole, which could have caused the neuropathy, but the symptoms and signs persisted.
  
  
  METHODS
  Baseline clinical examination, nerve conduction studies, serum vitamin and trace element levels, and glucose tolerance were measured. Then, 250 micrograms of trivalent chromium as the chloride salt was infused daily for 2 weeks. The above studies were repeated.
  
  
  RESULTS
  The patient at baseline had peripheral neuropathy of the axonal type and was glucose intolerant. Serum chromium was raised in this patient above the reference range. Despite raised serum levels, the infusion of chromium resulted in clinical remission that was marked 4 days after starting the infusion. Normalization of nerve conduction also occurred within 3 weeks of the initial study.
  
  
  CONCLUSIONS
  Neuropathy and glucose intolerance may occur despite increased serum chromium levels and respond to chromium infusion. The previous use of drugs such as metronidazole should not exclude chromium as a potential treatment for neuropathy in HPN patients.
authors.affiliation: Department of Medicine, St Michael's Hospital, Ontario, Canada.
authors.forename: A H
authors.initials: AH
authors.lastname: Verhage
authors.forename: W K
authors.initials: WK
authors.lastname: Cheong
authors.forename: K N
authors.initials: KN
authors.lastname: Jeejeebhoy
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002857:Chromium / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects*; D009431:Neural Conduction; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D010523:Peripheral Nervous System Diseases / Q000209:etiology*
chemical_list: D001786:Blood Glucose; D002857:Chromium; D008795:Metronidazole