Trace metal biochemistry : Influence of intravenous infusion of a multielement mixture

Trace element biochemistry following a multielement intravenous infusion in man was studied. A new trace-element additive mixture was prepared by Kabi-Vitrum, Sweden (code 4854). to meet the requirements of moderately ill patients. This mixture provided a daily supply of Fe 20 mumol (1.12 mg); Mn 100 mumol (6.54 mg); Cu 20 mumol (1.27 mg); Mn 15 mumol (0.82 mg); Cr 0.4 mumol (20.8 pg); Se 0.4 mumol (31.58 ug); Mo 0.2 mumol (19.19 ug); I 1.0 mumol (0.13 mg); F 50 mumol (0.95 mg). To evaluate the efficacy of this mixture in meeting the trace-element requirements in patients, three different studies were undertaken. Serum and urine samples were collected with precautions to avoid contamination. Levels of zinc, copper, manganese, chromium and selenium, in serum and urine were determined by proven atomic absorption techniques. Results were compared statistically within and between the groups and to appropriate reference values. This thesis deals with the determination of zinc, copper, manganese, chromium and selenium in serum and urine. Methods for Mo, I and F were not readily available. Studies were as follows: Crystalloid Study: In this study, twenty patients undergoing elective abdominal surgery were randomly allocated into two groups. Group A received saline and glucose (5%) only for four post-operative days. Group B received an additional daily infusion of trace-element mixture (code 4854). , In Group A serum zinc fell sharply, but returned to normal by day five. Serum copper, manganese, chromium and selenium were unchanged and urinary excretions did not alter. In Group B, serum zinc followed the same pattern as Group A, but serum copper and selenium were mostly unaffected. Serum and urinary chromium and manganese were markedly increased during infusion, whereas urinary zinc, copper and selenium were not significantly increased. Surgical I.V.N.: In this study, sixteen patients undergoing elective surgery were studied for more than seven days. They received 14 g N and 3000 KCal/day (2000 KCal as glucose, and 1000 KCal as Intralipid) and trace element additive mixture. These patients were divided into two groups. Group A as anabolic patients with urine N less than 12 g/day. Group B as catabolic patients with urine N greater than 14 g/day. In both groups, serum values of zinc, copper and selenium remained normal, while manganese and chromium increased. Urinary excretion of copper was unaffected, while that of zinc, manganese, chromium and selenium was increased. Medical I.V.N.: Four patients were studied for more than fourteen days. The infusion regimen was similar to that used in surgical IVN. Serum zinc and copper were maintained during infusion and manganese and chromium were elevated, while selenium was at the lower level of normal range. Urinary excretion was increased for chromium, zinc and manganese, while copper and selenium were unaffected. The supplement of zinc and copper was sufficient to correct any pre-existing abnormality and to maintain most of the patients. However, for patients with excessive intestinal fluid loss higher amounts may be desirable. The provision of manganese and chromium may have been excessive, only half of the amount provided may be enough for most patients. No clinical or biochemical abnormality suggestive of deficiency or toxicity for any of the infused elements was found