title: Dosing and monitoring of trace elements in long-term home parenteral nutrition patients.
abstract: BACKGROUND
  Trace elements (TEs) dosing and monitoring in home parenteral nutrition (PN) patients vary with their underlying conditions.
  
  
  METHODS
  This retrospective observational study evaluated parenteral TE dosing, serum TE concentrations and monitoring, and dose-concentration relationships between TE doses and serum TE concentrations in 26 adult and adolescent home PN patients.
  
  
  RESULTS
  There was a total of 40,493 PN days. Average parenteral zinc doses of 9.1 mg/d and 7.6 mg/d resulted in the majority of serum zinc concentrations (90%) within normal range in patients with and without short bowel syndrome (SBS), respectively. Selenium at about 70 mcg/d resulted in about 60% of serum selenium concentrations within normal range, with 38% of values below normal in patients with and without SBS alike. Copper at 1 mg/d resulted in 22.5% of serum copper concentrations above the normal range. The majority of serum manganese (94.6%) and chromium (96%) concentrations were elevated. Serum TE concentrations were infrequently monitored. Significant relationships existed between doses and serum concentrations for zinc (P < .0001), manganese (P = .012), and chromium (P < .0001) but not for selenium or copper.
  
  
  CONCLUSIONS
  TE doses in home PN should be individualized and adjusted based on regular monitoring of TE status. In long-term home PN patients, higher zinc and selenium doses may be necessary to maintain their normal serum concentrations. Lower copper doses and restrictions of manganese and chromium supplementation may be needed to avoid their accumulation. Relationships between TE doses and serum TE concentrations vary for each TE and underlying clinical conditions.
authors.affiliation: Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, USA. imadb@umich.edu
authors.forename: Imad F
authors.initials: IF
authors.lastname: Btaiche
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Carver
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003677:Deficiency Diseases / Q000097:blood / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019370:Observation; D044343:Overnutrition / Q000097:blood / Q000209:etiology*; D016331:Parenteral Nutrition, Home; D015995:Prevalence; D036301:Qualitative Research; D012016:Reference Values; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000097:blood / Q000150:complications / Q000628:therapy*; D014131:Trace Elements / Q000008:administration & dosage* / Q000097:blood*; D055815:Young Adult
chemical_list: D014131:Trace Elements