Excessive chromium intake in children receiving total parenteral nutrition

Moukarzel, Adib; Song, Min-Ae; Buchman, Alan L.; Vargas, Jorge; Guss, William; McDiarmid, Suzanne V.; Reyen, Laurie; Ament, Marvin E.

doi:10.1016/0140-6736(92)90078-h

Cited by 85 publications

(52 citation statements)

References 23 publications

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“…40 Although chromium toxicity in PN patients has not been reported, there are concerns of possible association between high serum chromium concentrations and decreased kidney function in children. 43 To the contrary, glucose intolerance and neuropathy were linked to chromium deficiency in early studies of home PN patients. [44][45][46] In long-term PN patients, supplemental chromium may not be necessary, and chromium supplementation based on A.S.P.E.N.…”

Section: Chromiummentioning

confidence: 99%

“…Chromium contamination in PN is well documented and varies between manufacturers and product lots. 12,[39][40][41][42][43] Chromium contaminants in parenteral products may contribute up to 100% more of chromium intake, 43 causing up to a 40-fold increase in serum chromium concentrations and substantially higher tissue chromium accumulation. 40 In our study, serum chromium concentrations reached about 23-fold (6.85 ng/ mL) the upper reference range (0.3 ng/mL).…”

Section: Chromiummentioning

confidence: 99%

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Dosing and Monitoring of Trace Elements in Long‐Term Home Parenteral Nutrition Patients

Btaiche

Carver

Welch

2011

J Parenter Enteral Nutr

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Section: Chromiummentioning

confidence: 99%

Section: Chromiummentioning

confidence: 99%

Dosing and Monitoring of Trace Elements in Long‐Term Home Parenteral Nutrition Patients

Btaiche

Carver

Welch

2011

J Parenter Enteral Nutr

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“…97,98 The trace elements chromium and zinc are the most frequently measured as contaminants in a number of PN components. 90,91,95,[99][100][101][102] This may necessitate the use of individual rather than fixeddose multi-trace element products to allow dosing flexibility for patient PN regimens when contaminants are of concern. Further research is recommended on micronutrient contamination of PN.…”

Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

265

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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“…(1) Disruption of the enterohepatic cycle (ileal disease or resection) [47,48] (2) Intestinal stasis with subsequent intraluminal bacterial overgrowth and/or translocation (endotoxinemia) [49] (3) Recurrent catheter-related sepsis [50,51] (4) Prematurity [51] (5) Inadequate macronutrient intake such as continuous PN infusion with excessive glucose intake leading to hyperinsulinism and subsequent steatosis [52] and inadequate amino acid supply [49] (6) Excessive intake of long-chain polyunsaturated fatty acids with subsequent lipoperoxidation [53,54] and high content of phytosterols from soybean oil-based emulsions [55] (7) Aluminum, iron and/or chromium overloads [56][57][58] Premature and/or small for gestational age infants with severe necrotizing enterocolitis are at especially high risk of developing liver disease and early end-stage liver failure because of the combination of prematurity, subocclusion, Gram-negative sepsis, protracted bowel rest, continuous instead of cyclic PN infusion, and repeated catheter-related sepsis.…”

Section: Factors and Management Of Liver Diseasementioning

confidence: 99%

Congenital Enteropathy and Intestinal Transplantation

Goulet

2005

Ann Nestlé [Engl]

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Intestinal failure (IF) requires the use of parenteral nutrition (PN). Causes of severe protracted IF include short bowel syndrome, severe motility disorders (total or subtotal aganglionosis or chronic intestinal pseudo-obstruction syndrome) and congenital diseases of enterocyte development. Severe liver disease may develop in patients with IF as a consequence of both underlying digestive disease and unadapted PN. Catheter-related sepsis and/or extensive vascular thrombosis may impede the continuation of safe and efficient PN. Thus management of patients with IF requires early recognition of the condition and the analysis of its risk of irreversibility. Timing of referral for intestinal transplantation remains a crucial issue. As a consequence, management should include therapies adapted to each stage of IF based on a multidisciplinary approach in centers involving pediatric gastroenterology, PN expertise, home-PN program, pediatric surgery, liver-intestinal transplantation program.

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Excessive chromium intake in children receiving total parenteral nutrition

Cited by 85 publications

References 23 publications

Dosing and Monitoring of Trace Elements in Long‐Term Home Parenteral Nutrition Patients

Dosing and Monitoring of Trace Elements in Long‐Term Home Parenteral Nutrition Patients

A.S.P.E.N. Clinical Guidelines

Congenital Enteropathy and Intestinal Transplantation

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