Neurologic Symptoms Due to Possible Chromium Deficiency in Long‐Term Parenteral Nutrition That Closely Mimic Metronidazole‐Induced Syndromes

Verhage, Albert H.; Cheong, Wei Kiong; Jeejeebhoy, Khursheed N.

doi:10.1177/0148607196020002123

Cited by 41 publications

(8 citation statements)

References 38 publications

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“…Acute beriberi with severe thiamine deficiency has been reported and can be life threatening [61]. Iron deficiency anemia is common with TPN [62], and clinically significant sequelae can be seen with deficiencies of selenium [63], copper [64], zinc [65], and chromium [66]. Conversely, trace element toxicity can have serious effects, as with manganese neurotoxicity, which may develop with concomitant cholestatic liver disease [67], and aluminum-related bone disease, as described previously.…”

Section: Other Metabolic Disordersmentioning

confidence: 89%

Metabolic and catheter complications of parenteral nutrition

Ghabril

Aranda-Michel

Scolapio

2004

Curr Gastroenterol Rep

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Since its introduction in the 1960s, total parenteral nutrition (TPN) has played a vital role in improving clinical outcomes for patients with acute and chronic illnesses. The evolution of TPN solutions and vascular access techniques, combined with an increased awareness and better understanding of the physiology of TPN, have improved the safety of this therapy. Nevertheless, complications are not uncommon and can be life threatening. This article provides an updated review on the metabolic and catheter complications associated with TPN.

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Section: Other Metabolic Disordersmentioning

confidence: 89%

Metabolic and catheter complications of parenteral nutrition

Ghabril

Aranda-Michel

Scolapio

2004

Curr Gastroenterol Rep

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“…Another case study by Verhage et al (1996) reported on a 40-year-old man who had undergone multiple intestinal resections over 11 years, as a result of Crohn's disease, and received TPN for six months while recovering from an injury to the bowel. The TPN solution was reported to provide 5 µg/day of chromium with an estimated additional 2.4-10.5 µg/day of chromium by contamination from the component solutions (Ito et al, 1990).…”

Section: Deficiencymentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for chromium

Products¹

2014

EFSA Journal

180

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Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) considered the evidence for setting Dietary Reference Values for chromium. Trivalent chromium (Cr(III)) has been postulated to be necessary for the efficacy of insulin in regulating the metabolism of carbohydrates, lipids and proteins. However, the mechanism(s) for these roles and the essential function of Cr(III) in metabolism have not been substantiated. The criteria for the essentiality of a trace element were considered. It was noted that attempts to create chromium deficiency in animal models have not produced consistent results, and that there is no evidence of essentiality of Cr(III) in animal nutrition. Evaluating the possibility of Cr(III) as an essential element for humans, the evidence from reported improvements associated with chromium supplementation in patients on total parenteral nutrition was considered to be the most convincing, but overall data do not provide sufficient information on the reversibility of the possible deficiencies and the nature of any dose-response curve in order to identify a dietary requirement for humans. The Panel concludes that no Average Requirement and no Population Reference Intake for chromium can be defined. Several studies assessed the effect of chromium supplementation on glucose and/or lipid metabolism. In the only study for which information on total chromium intake was available, there was no difference in parameters of glucose metabolism of normoglycaemic subjects between the placebo and chromium-supplemented periods. The Panel considered that there is no evidence of beneficial effects associated with chromium intake in healthy subjects. The Panel concluded that the setting of an Adequate Intake for chromium is also not appropriate. In 1993, the Scientific Committee for Food was unable to define a specific physiological requirement of chromium and did not propose DRVs for chromium, but other authorities have subsequently proposed DRVs for chromium. © European FoodTrivalent chromium (Cr(III)) has been reported as an essential trace element in that it has been postulated to be necessary for the efficacy of insulin in regulating the metabolism of carbohydrates, lipids and proteins. However, at present, the mechanism(s) for these roles and the essential function of chromium in metabolism have not been substantiated. The postulation of chromium's essentiality for humans was almost entirely based on case reports of patients on long-term total parenteral nutrition (TPN) who developed metabolic and neurological defects, which were reported to respond to supplementation with Cr(III). The Panel noted that the chromium concentrations in the TPN solutions that induced the presumed deficiency symptoms were not reported in all the patients studied. In the three studies in which the concentration of chromium in the TPN solution was reported, the daily chromium supply was between 5 and 10 µg; at an absorption efficiency of 5 % this amount of infused chromium ...

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“…Extreme signs of Cr deficiency observed in patients on TPN also include neurologic disorders. Chromium is now routinely added to TPN solutions but may not be adequate under stress conditions since neuropathy of a patient on TPN, who was also receiving metronidazole, was reversed by further addition of Cr to the TPN solutions [14].…”

Section: Dietary Chromium Intake Requirement and Signs Of Deficiencymentioning

confidence: 99%

Nutritional factors influencing the glucose/insulin system: chromium.

Anderson

1997

Journal of the American College of Nutrition

139

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Chromium (Cr) improves the glucose/insulin system in subjects with hypoglycemia, hyperglycemia, diabetes and hyperlipemia with no detectable effects on control subjects. Chromium improves insulin binding, insulin receptor number, insulin internalization, beta cell sensitivity and insulin receptor enzymes with overall increases in insulin sensitivity. There have been several studies involving Cr supplementation of subjects with NIDDM and/or lipemia and most have reported beneficial effects of Cr on the glucose/insulin system. In a recent study, Chinese subjects with NIDDM were divided into three groups of 60 subjects and supplemented with placebo, 100 or 500 micrograms of Cr as chromium picolinate 2 times per day for 4 months. Improvements in the glucose/insulin system were highly significant in the subjects receiving 500 micrograms twice per day with less or no significant improvements in the subjects receiving 100 micrograms twice per day after 2 and 4 months. In summary, Cr is involved in the control of the glucose/insulin system and the amount, and likely form of chromium, are critical when evaluating the role of chromium in this system.

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Neurologic Symptoms Due to Possible Chromium Deficiency in Long‐Term Parenteral Nutrition That Closely Mimic Metronidazole‐Induced Syndromes

Abstract: Neuropathy and glucose intolerance may occur despite increased serum chromium levels and respond to chromium infusion. The previous use of drugs such as metronidazole should not exclude chromium as a potential treatment for neuropathy in HPN patients.

Cited by 41 publications

References 38 publications

Metabolic and catheter complications of parenteral nutrition

Metabolic and catheter complications of parenteral nutrition

Scientific Opinion on Dietary Reference Values for chromium

Nutritional factors influencing the glucose/insulin system: chromium.

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