Document Detail

Trace element loss in urine and effluent following traumatic injury.
MedLine Citation:
PMID:  18407905     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Few data are available to establish recommendations for trace element supplementation during critical illness. This study quantified the loss of several elements and assessed the adequacy of manganese and selenium in parenteral nutrition (PN). METHODS: Men with traumatic injuries were grouped by renal status: adequate (POLY; n = 6), acute failure with continuous venovenous hemofiltration (CVVH; n = 2), or continuous venovenous hemodiafiltration (CVVHD; n = 4). PN supplied 300 microg/d manganese and 60 microg/d selenium. Urine and effluent (from artificial kidneys) were collected for 3 days and analyzed for boron, manganese, nickel, and silicon using inductively coupled plasma atomic emission spectrometry, and for selenium using atomic absorption spectrometry. RESULTS: POLY manganese and selenium excretion averaged (standard deviation [SD]) 7.9 (3.3) microg/d and 103.5 (22.4) microg/d, respectively. All elements except selenium were detected in dialysate (prior to use). CVVHD effluent contained 3.5 and 7.3 times more manganese and nickel than CVVH ultrafiltrate, respectively. Loss of manganese averaged 2.6%, 21%, and 73% of PN amounts for POLY, CVVH, and CVVHD groups, respectively. DISCUSSION: Minimal loss of manganese compared with the amount in PN suggests that excessive amounts are retained. POLY patients excreted more selenium than was in PN, indicating negative balance. POLY losses of boron and silicon were less than that published for healthy adults, reflecting less than typical intake, whereas loss during CVVH was in the normal reference range, possibly because of added intake from boron contamination of replacement fluids. All patients lost more nickel than amounts published for healthy adults. CONCLUSIONS: Current guidelines of 60-100 microg/d of parenteral manganese may be excessive for trauma patients. The uptake of manganese and nickel from contaminants in CVVHD dialysate should be investigated.
Catherine J Klein; Forrest H Nielsen; Phylis B Moser-Veillon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  32     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2008 Mar-Apr
Date Detail:
Created Date:  2008-04-14     Completed Date:  2008-06-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  129-39     Citation Subset:  IM    
Bionutrition Research Program, General Clinical Research Center, Children's National Medical Center, Washington, DC 20010, USA.
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MeSH Terms
Boron / analysis,  urine
Critical Illness / therapy*
Food Contamination / analysis
Kidney Failure, Acute / metabolism*,  therapy
Manganese / administration & dosage,  analysis,  urine
Middle Aged
Nickel / administration & dosage,  analysis,  urine
Nutritional Requirements
Parenteral Nutrition* / adverse effects
Renal Replacement Therapy*
Selenium / administration & dosage,  analysis,  urine
Silicon / administration & dosage,  analysis,  urine
Trace Elements / administration & dosage,  analysis*,  urine
Reg. No./Substance:
0/Trace Elements; 7439-96-5/Manganese; 7440-02-0/Nickel; 7440-21-3/Silicon; 7440-42-8/Boron; 7782-49-2/Selenium

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