trace metal combination additive

REMS

Administered as a component in total parenteral nutrition (TPN, parenteral hyperalimentation).
May contain any or all of the following:
- Chromium,
- Copper,
- Iodine,
- Manganese,
- Molybdenum,
- Selenium,
- Zinc.

Action ⬆ ⬇

Trace metals serve as cofactors or catalysts for numerous diverse homeostatic processes.

Therapeutic effects:

Replacement in deficiency states when oral ingestion is not feasible.

Pharmacokinetics ⬆ ⬇

Absorption: Administered IV only, resulting in complete bioavailability.

Distribution: Widely distributed.

Metabolism/Excretion: Excretion depends on individual trace element.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(replacement)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to iodine (iodine-containing products only).

Use Cautiously in:

OB: Pregnancy or lactation;
NG suction, fistula drainage, prolonged vomiting or diarrhea (may increase requirements);
Renal impairment or biliary obstruction (may increase risk of toxicity);
Isolated trace element deficiency (other additives may be excessive—use only those required).

Adv. Reactions/Side Effects ⬆ ⬇

Listed for individual trace metals—usually associated with toxicity

Misc: ChromiumCOMA, SEIZURES, GI ulceration, hepatic damage, nausea, renal damage, vomiting, Copperbehavioral changes, diarrhea, peripheral edema, photophobia, progressive marasmus, weakness, Iodineacneiform skin lesions, headache, increased salivation, metallic taste, parotitis, runny nose, sneezing, sore mouth, swelling of eyelids, Manganeseanorexia, apathy, gait disturbances, headache, erectile dysfunction, irritability, speech difficulties, Molybdenumgout-like syndrome, Seleniumgarlic-like breath, garlic-like sweat, GI discomfort, hair loss, mental depression, metallic taste, nervousness, vomiting, weak nails, Zincblurred vision, hypotension, jaundice, loss of consciousness, oliguria, pulmonary edema, tachycardia, toxicity poorly defined but may include hypothermia, vomiting

Interactions ⬆ ⬇

Drug-drug:

None significant in replacement doses.

Route/Dosage ⬆ ⬇

IV (Adults and Children ): Amount necessary to maintain normal trace element levels.

Availability ⬆ ⬇

All must be diluted in large-volume parenterals prior to use

Injection: Each mL contains 0.85–4 mcg chromium, 0.1–0.4 mg copper, 0.025–0.16 mg manganese, and 0.5–1.5 mg zinc. Some products also contain iodide, selenium, and molybdenum
Concentrated injection: Each mL contains 10 mcg chromium, 1 mg copper, 0.5 mg manganese, and 5 mg zinc. Some products also contain iodide and selenium

Assessment ⬆ ⬇

Assess nutritional status by 24-hr recall prior to therapy.
Monitor patient for signs and symptoms of trace metal deficiencies prior to and throughout therapy, as follows:.
Chromium: glucose intolerance, ataxia, peripheral neuropathy, confusion.
Copper: leukopenia, neutropenia, anemia, iron deficiency, skeletal abnormalities, defective tissue formation.
Iodine: impaired thyroid function, goiter, cretinism.
Manganese: nausea, vomiting, weight loss, dermatitis, changes in hair.
Molybdenum: tachycardia, tachypnea, headache, night blindness, nausea, vomiting, edema, lethargy, disorientation, coma, hypouricemia, hypouricosuria.
Selenium: cardiomyopathy, muscle pain, kwashiorkor, Keshan disease.
Zinc: diarrhea, apathy, depression, anorexia, hypogonadism, growth retardation, anemia, hepatosplenomegaly, impaired wound healing, decreased sense of taste and smell.

Lab Test Considerations:

Serum trace metal concentrations should be monitored periodically throughout TPN therapy.

Implementation ⬆ ⬇

IV Administration:

IV: Solution usually does not contain preservatives; discard unused portion.
Continuous Infusion: Diluent: Must be diluted prior to administration. Dilute each dose in at least 1 liter of IV solution.
Rate: Administer at prescribed rate for TPN infusion.
Additive Compatibility: Usually compatible with other trace metals, electrolytes, and dextrose/amino acid combinations used for TPN.

Patient/Family Teaching ⬆ ⬇

Explain purpose of infusion of TPN and components to patient.

Evaluation/Desired Outcomes ⬆ ⬇

Prevention or treatment of trace metal deficiencies.

US Brand Names ⬆ ⬇

Concentrated Multiple Trace Element, ConTE-PAK-4, M.T.E.-4, M.T.E.-4 Concentrated, M.T.E.-5, M.T.E.-5 Concentrated, M.T.E.-6, M.T.E.-6 Concentrated, M.T.E.-7, MulTE-PAK-4, MulTE-PAK-5, Multiple Trace Element, Multiple Trace Element Neonatal, Multiple Trace Element Pediatric, Neotrace 4, PedTE-PAK-4, Pedtrace-4, P.T.E.-4, P.T.E.-5

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Classifications ⬇

Indications ⬆ ⬇