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Trace Elements

Medically reviewed by Drugs.com. Last updated on May 26, 2020.

Pronunciation

(trase EL e ments)

Index Terms

  • Chromium
  • Copper
  • Manganese
  • Neonatal Trace Metals
  • Peditrace
  • Selenium
  • Trace Metals
  • Trace Minerals
  • Zinc

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Multitrace-4: chromium 4 mcg, copper 400 mcg, manganese 100 mcg, and zinc 1,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]

Multitrace-5: chromium 4 mcg, copper 400 mcg, manganese 100 mcg, selenium 20 mcg, and zinc 1,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]

Multitrace-4 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, and zinc 5,000 mcg per 1 mL (1 mL [DSC])

Multitrace-4 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, and zinc 5,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]

Multitrace-4 Neonatal: chromium 0.85 mcg, copper 100 mcg, manganese 25 mcg, and zinc 1,500 mcg per 1 mL (2 mL)

Multitrace-5 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, selenium 60 mcg, and zinc 5,000 mcg per 1 mL (1 mL)

Multitrace-5 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, selenium 60 mcg, and zinc 5,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]

Trace Elements 4/Pediatric: chromium 1 mcg, copper 100 mcg, manganese 30 mcg, and zinc 500 mcg per 1 mL (10 mL) [contains benzyl alcohol]

Solution, Intravenous [preservative free]:

Multitrace-4 Pediatric: chromium 1 mcg, copper 100 mcg, manganese 25 mcg, and zinc 1,000 mcg per 1 mL (3 mL)

Tralement: copper 300 mcg, manganese 55 mcg, selenium 60 mcg, and zinc 3,000 mcg per 1 mL (1 mL)

Brand Names: U.S.

  • Multitrace-4 Concentrate [DSC]
  • Multitrace-4 Neonatal
  • Multitrace-4 Pediatric
  • Multitrace-4 [DSC]
  • Multitrace-5 Concentrate
  • Multitrace-5 [DSC]
  • Trace Elements 4/Pediatric
  • Tralement

Pharmacologic Category

  • Trace Element, Parenteral

Pharmacology

Chromium: Helps to maintain normal glucose metabolism and peripheral nerve function and prevents development of impaired glucose tolerance, ataxia, peripheral neuropathy, and a confusional state similar to mild/moderate hepatic encephalopathy.

Copper: Cofactor for serum ceruloplasmin, an oxidase necessary for proper formation of the iron carrier protein, transferrin; also helps maintain normal rates of red and white blood cell formation and prevents development of leukopenia, neutropenia, anemia, depressed ceruloplasmin levels, impaired transferrin formation and secondary iron deficiency.

Manganese: Activator for enzymes such as polysaccharide polymerase, liver arginase, cholinesterase and pyruvate carboxylase and prevents development of nausea and vomiting, weight loss, dermatitis, and changes in growth and hair color.

Selenium: Protects cell components from oxidative damage due to peroxides produced in cellular metabolism and prevents development of muscle pain and tenderness.

Zinc: Facilitates wound healing, helps maintain normal growth rates, normal skin hydration and senses of taste and smell and prevents development of parakeratosis, hypogeusia, anorexia, dysosmia, geophagia, hypogonadism, growth retardation and hepatosplenomegaly.

Excretion

Chromium: Urine and bile

Copper: Feces

Manganese: Feces (primarily); ancillary routes via pancreatic secretions or reabsorption into the intestinal lumen

Selenium: Urine, feces

Zinc: Urine, feces

Use: Labeled Indications

Trace element supplement for parenteral nutrition: Prevent and correct trace element deficiencies as a supplement to parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.

Contraindications

Hypersensitivity to zinc, copper, or any component of the formulation; administration of undiluted solutions by direct injection into a peripheral vein.

Dosing: Adult

Trace element supplement for parenteral nutrition: IV:

Manufacturer’s labeling (may vary based on formulation):

Chromium: 10 to 15 mcg/day (20 mcg/day with intestinal fluid loss)

Copper: 300 to 1,500 mcg/day

Manganese: 55 to 800 mcg/day

Selenium: 20 to 60 mcg/day

Zinc: 2.5 to 4 mg/day. Consider an additional 2 mg/day for acute catabolic states; with fluid loss from the small bowel, an additional 12.2 mg/L of small bowel fluid lost, or an additional 17.1 mg/kg of stool or ileostomy output is recommended.

ASPEN Guidelines (Mirtallo 2004):

Chromium: 10 to 15 mcg/day

Copper: 300 to 500 mcg/day

Manganese: 60 to 100 mcg/day

Selenium: 20 to 60 mcg/day

Zinc: 2.5 to 5 mg/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Parenteral nutrition; maintenance requirements: Infants, Children, and Adolescents: IV: As an additive to parenteral nutrition solution; see individual agents (chromium, copper, manganese, and zinc) (ASPEN [Vanek 2012])

Administration

For IV use only. Must be diluted prior to use and infused as component of parenteral nutrition or parenteral solutions. Do not administer undiluted solutions by direct injection into a peripheral vein.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Warnings/Precautions

Disease-related concerns:

• GI malfunction: Consider reduction in dosage or deletion of selenium in patients with GI malfunction.

• Hepatic impairment: Copper and manganese may accumulate in severe hepatic impairment and/or biliary obstruction; consider reduction in dosage or deletion of copper and manganese in patients with severe hepatic impairment or biliary obstruction.

• Renal impairment: Use with caution in patients with renal impairment; metals may accumulate in renal failure. Consider reduction in dosage or deletion of selenium in patients with renal impairment.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.

Other warnings/precautions:

• Aluminum toxicity: Contains aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or in patients with renal impairment. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses.

• Manganese toxicity: Basal ganglia accumulation (detected on MRI) and clinical symptoms (eg, neuropsychiatric, seizures, parkinsonian-like tremor, dysarthria, mask-face, halting gate, dystonic movements) of manganese toxicity have been reported in adult and pediatric patients, including patients receiving manganese at or below recommended doses and with normal blood manganese levels. Risk may be increased in patients receiving higher than recommended doses and with cholestatic liver disease. Symptoms and MRI findings generally improve over weeks to months following discontinuation of manganese but may not completely resolve. Monitor manganese blood levels and for neurologic toxicity in patients receiving manganese long-term as a component of parenteral nutrition therapy. If manganese toxicity is suspected, temporarily discontinue and further evaluate.

• Overdose potential: Multiple trace metal solutions present a risk of overdosage when the need for one trace element is appreciably higher than for others in the formulation; utilization of individual trace metal solutions may be needed.

Monitoring Parameters

Periodically monitor plasma zinc, copper, manganese, chromium and selenium, with more frequent monitoring in patients receiving more than the usual dose or long-term therapy.

Pregnancy Considerations

Refer to individual elements for requirements in pregnancy.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.