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May 11, 1979, Vol 241, No. 19 >
ARTICLE | May 11, 1979

Guidelines for Essential Trace Element Preparations for Parenteral Use: Title and subTitle BreakA Statement by an Expert Panel FREE

[+] Author Affiliations

Prepared by the Expert Panel for Nutrition Advisory Group, AMA Department of Foods and Nutrition. For a complete listing of panel members, see p 2054.

Reprint requests to AMA Department of Foods and Nutrition, American Medical Association, 535 N Dearborn St, Chicago, IL 60610.


JAMA. 1979;241(19):2051-2054. doi:10.1001/jama.1979.03290450049024
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References

IN RECENT years the medical profession has focused increasing attention on the importance of trace elements in the nutritional management of medical, surgical, and traumatic conditions. New information on requirements and reports of trace element deficiencies in patients receiving intravenous (IV) nutrition emphasize the need for ensuring proper levels of trace elements in solutions for IV feeding, particularly when the parenteral route is the sole or primary source of nutrients for prolonged periods.

On Oct 7, 1977, the Nutrition Advisory Group of the Department of Foods and Nutrition, American Medical Association, convened a group of experts on trace elements. The group included physicians in the specialties of pediatrics, surgery, and medicine; biochemists and pharmacists; and representatives of the Food and Drug Administration, the United States Pharmacopeia, and the pharmaceutical'industry. Four major topics were discussed: (1) current knowledge of requirements for trace elements in health and disease; (2) modification of dietary

REFERENCES

1 +
Jeejeebhoy KN, Chu RC, Marliss EB, et al:  Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition . Am J Clin Nutr 30:531-538, 1977;.
2 +
Burch RE, Sullivan JF:  Diagnosis of zinc, copper, and manganese abnormalities in man . Med Clin North Am 60:655-660, 1976;.
3 +
Allison R:  Plasma trace elements during total parenteral nutrition . JPEN 2:35-40, 1978;.
4 +
Shils ME, Wright WL, Turnbull A, et al:  Long-term parenteral nutrition through an external arteriovenous shunt: Report of a case . N Engl J Med 283:341-344, 1970;.
5 +
Shils ME:  A program for total parenteral nutrition at home . Am J Clin Nutr 28:1429-1435, 1975;.
6 +
Wolman SL, Anderson GH, Marliss EB, et al:  Zinc in total parenteral nutrition: Requirements and metabolic effects . Gastroenterology 76:458-467, 1979;.
7 +
Arakawa T, Tamura T, Igarashi Y, et al:  Zinc deficiency in two infants during total parenteral alimentation for diarrhea . Am J Clin Nutr 29:197-204, 1976;.
8 +
Kay RG, Tasman-Jones C, Pybus J, et al:  A syndrome of acute zinc deficiency during total parenteral alimentation in man . Ann Surg 183:331-340, 1976;.
9 +
Jacobson S, Wester PO:  Balance study of 20 trace elements during total parenteral nutrition in man . Br J Nutr 37:107-126, 1977;.
10 +
Tucker SB, Schroeter AL, Brown PW Jr, et al:  Acquired zinc deficiency: Cutaneous manifestations typical of acrodermatitis enteropathica . JAMA 235:2399-2402, 1976;.
11 +
Hankins DA, Riella MC, Scribner BH, et al:  Whole blood trace element concentrations during total parenteral nutrition . Surgery 79:674-677, 1976;.
12 +
Solomons NW, Layden TJ, Rosenberg IH, et al:  Plasma trace metals during total parenteral alimentation . Gastroenterology 70:1022-1025, 1976;.
13 +
MacMahon RA, Parker MLM, McKinnon MC:  Zinc treatment in malabsorption . Med J Aust 2:210-212, 1968;.
14 +
Greene HL, Hambidge M, Hermer YF:  Trace elements and vitamins . Adv Exp Med Biol 46:131-145, 1974;.
15 +
James BE, MacMahon RA:  Balance studies of nine elements during complete intravenous feeding of small premature infants . Aust Paediatr J 12:154-162, 1976;.
16 +
Karpel J, Peden V:  Copper deficiency in long-term parenteral nutrition . J Pediatr 80:32-36, 1972;.
17 +
Vilter RW, Bozian RC, Hess EV, et al:  Manifestations of copper deficiency in a patient with systemic sclerosis on intravenous hyperalimentation . N Engl J Med 291:188-191, 1974;.
18 +
Fleming CR, Hodges RE, Hurley LS:  A prospective study of serum copper and zinc levels in patients receiving total parenteral nutrition . Am J Clin Nutr 29:70-77, 1976;.
19 +
Hull RL, Cassidy D:  Trace element deficiencies during total parenteral nutrition: A case of sideroblastic anemia due to inadequate copper replacement . Drug Intell Clin Pharmacy 11:536-541, 1977;.
20 +
Dauncey MJ, Shaw JCL, Urman J:  The absorption and retention of magnesium, zinc, and copper by low birth weight infants fed pasteurized human breast milk . Pediatr Res 11:1033-1039, 1977;.
21 +
Widdowson EM, Dauncey MJ, Shaw JCL:  Trace elements in feotal and early postnatal development . Proc Nutr Soc 33:275-284, 1974;.
22 +
Greene HL, Helinek G, Vanderform D:  Serum zinc and copper levels in very low birth weight infants up to 2 years of age . Acta Paediatr Scand , to be published.
23 +
Sandstead HH, Klevay LM, Jacob RA, et al:  Effects of dietary fiber and protein level on mineral element metabolism , in Inglett GE, Falkehag I (eds): Dietary Fibers: Chemistry and Nutrition . New York, Academic Press Inc, in press.
24 +
National Research Council, Food and Nutrition Board: Recommended Dietary Allowances , ed 8. Washington, DC, National Academy of Sciences, 1974;.
25 +
 WHO Expert Committee Report: Trace elements in human nutrition . WHO Tech Rep Ser 532:1-70, 1973;.
26 +
Cartwright GE, Wintrobe MM:  Copper metabolism in normal subjects . Am J Clin Nutr 14:224-232, 1964;.
27 +
Greene HL:  Trace metals in parenteral nutrition , in Brewer GJ, Prasad AS (eds): Zinc Metabolism . New York, Alan R. Liss, 1977;, p 87.
28 +
Hauer EC, Kaminski MV:  Trace metal profile of parenteral nutrition solutions . Am J Clin Nutr 31:264-268, 1978;.
29 +
Hoffman RP, Ashby DM:  Trace element concentrations in commercially available solutions . Drug Intell Clin Pharm 10:74-76, 1976;.
30 +
Jetton MM, Sullivan JF, Burch RE:  Trace element contamination of intravenous solutions . Arch Intern Med 136:782-784, 1976;.
31 +
Wretlind A:  Complete intravenous nutrition: Theoretical and experimental background . Nutr Metab 14( (suppl) ):1-57, 1972;.
32 +
Shils ME:  Minerals in total parenteral nutrition , in Symposium on Total Parenteral Nutrition . Chicago, American Medical Association, 1972;, pp 92-114.
33 +
James BE, Henry P, MacMahon RA:  Mineral requirements in low birth weight infants . Aust Paediatr J , to be published.
34 +
Greene HL, Vanderform D, Helinek GL:  Trace elements in parental feeding of infants , in Visser HKA (ed): V Nutricia Symposium: Nutrition and Metabolism of the Fetus and Infant . Leiden, Netherlands, Stenfert Kroese, to be published.

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1 +
Jeejeebhoy KN, Chu RC, Marliss EB, et al:  Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition . Am J Clin Nutr 30:531-538, 1977;.
2 +
Burch RE, Sullivan JF:  Diagnosis of zinc, copper, and manganese abnormalities in man . Med Clin North Am 60:655-660, 1976;.
3 +
Allison R:  Plasma trace elements during total parenteral nutrition . JPEN 2:35-40, 1978;.
4 +
Shils ME, Wright WL, Turnbull A, et al:  Long-term parenteral nutrition through an external arteriovenous shunt: Report of a case . N Engl J Med 283:341-344, 1970;.
5 +
Shils ME:  A program for total parenteral nutrition at home . Am J Clin Nutr 28:1429-1435, 1975;.
6 +
Wolman SL, Anderson GH, Marliss EB, et al:  Zinc in total parenteral nutrition: Requirements and metabolic effects . Gastroenterology 76:458-467, 1979;.
7 +
Arakawa T, Tamura T, Igarashi Y, et al:  Zinc deficiency in two infants during total parenteral alimentation for diarrhea . Am J Clin Nutr 29:197-204, 1976;.
8 +
Kay RG, Tasman-Jones C, Pybus J, et al:  A syndrome of acute zinc deficiency during total parenteral alimentation in man . Ann Surg 183:331-340, 1976;.
9 +
Jacobson S, Wester PO:  Balance study of 20 trace elements during total parenteral nutrition in man . Br J Nutr 37:107-126, 1977;.
10 +
Tucker SB, Schroeter AL, Brown PW Jr, et al:  Acquired zinc deficiency: Cutaneous manifestations typical of acrodermatitis enteropathica . JAMA 235:2399-2402, 1976;.
11 +
Hankins DA, Riella MC, Scribner BH, et al:  Whole blood trace element concentrations during total parenteral nutrition . Surgery 79:674-677, 1976;.
12 +
Solomons NW, Layden TJ, Rosenberg IH, et al:  Plasma trace metals during total parenteral alimentation . Gastroenterology 70:1022-1025, 1976;.
13 +
MacMahon RA, Parker MLM, McKinnon MC:  Zinc treatment in malabsorption . Med J Aust 2:210-212, 1968;.
14 +
Greene HL, Hambidge M, Hermer YF:  Trace elements and vitamins . Adv Exp Med Biol 46:131-145, 1974;.
15 +
James BE, MacMahon RA:  Balance studies of nine elements during complete intravenous feeding of small premature infants . Aust Paediatr J 12:154-162, 1976;.
16 +
Karpel J, Peden V:  Copper deficiency in long-term parenteral nutrition . J Pediatr 80:32-36, 1972;.
17 +
Vilter RW, Bozian RC, Hess EV, et al:  Manifestations of copper deficiency in a patient with systemic sclerosis on intravenous hyperalimentation . N Engl J Med 291:188-191, 1974;.
18 +
Fleming CR, Hodges RE, Hurley LS:  A prospective study of serum copper and zinc levels in patients receiving total parenteral nutrition . Am J Clin Nutr 29:70-77, 1976;.
19 +
Hull RL, Cassidy D:  Trace element deficiencies during total parenteral nutrition: A case of sideroblastic anemia due to inadequate copper replacement . Drug Intell Clin Pharmacy 11:536-541, 1977;.
20 +
Dauncey MJ, Shaw JCL, Urman J:  The absorption and retention of magnesium, zinc, and copper by low birth weight infants fed pasteurized human breast milk . Pediatr Res 11:1033-1039, 1977;.
21 +
Widdowson EM, Dauncey MJ, Shaw JCL:  Trace elements in feotal and early postnatal development . Proc Nutr Soc 33:275-284, 1974;.
22 +
Greene HL, Helinek G, Vanderform D:  Serum zinc and copper levels in very low birth weight infants up to 2 years of age . Acta Paediatr Scand , to be published.
23 +
Sandstead HH, Klevay LM, Jacob RA, et al:  Effects of dietary fiber and protein level on mineral element metabolism , in Inglett GE, Falkehag I (eds): Dietary Fibers: Chemistry and Nutrition . New York, Academic Press Inc, in press.
24 +
National Research Council, Food and Nutrition Board: Recommended Dietary Allowances , ed 8. Washington, DC, National Academy of Sciences, 1974;.
25 +
 WHO Expert Committee Report: Trace elements in human nutrition . WHO Tech Rep Ser 532:1-70, 1973;.
26 +
Cartwright GE, Wintrobe MM:  Copper metabolism in normal subjects . Am J Clin Nutr 14:224-232, 1964;.
27 +
Greene HL:  Trace metals in parenteral nutrition , in Brewer GJ, Prasad AS (eds): Zinc Metabolism . New York, Alan R. Liss, 1977;, p 87.
28 +
Hauer EC, Kaminski MV:  Trace metal profile of parenteral nutrition solutions . Am J Clin Nutr 31:264-268, 1978;.
29 +
Hoffman RP, Ashby DM:  Trace element concentrations in commercially available solutions . Drug Intell Clin Pharm 10:74-76, 1976;.
30 +
Jetton MM, Sullivan JF, Burch RE:  Trace element contamination of intravenous solutions . Arch Intern Med 136:782-784, 1976;.
31 +
Wretlind A:  Complete intravenous nutrition: Theoretical and experimental background . Nutr Metab 14( (suppl) ):1-57, 1972;.
32 +
Shils ME:  Minerals in total parenteral nutrition , in Symposium on Total Parenteral Nutrition . Chicago, American Medical Association, 1972;, pp 92-114.
33 +
James BE, Henry P, MacMahon RA:  Mineral requirements in low birth weight infants . Aust Paediatr J , to be published.
34 +
Greene HL, Vanderform D, Helinek GL:  Trace elements in parental feeding of infants , in Visser HKA (ed): V Nutricia Symposium: Nutrition and Metabolism of the Fetus and Infant . Leiden, Netherlands, Stenfert Kroese, to be published.

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