Chromium Chloride + Copper Sulphate + Manganese Sulphate + Selenious acid

Usage

• This combination of trace elements is prescribed for the treatment and prevention of nutritional deficiencies, particularly in patients receiving total parenteral nutrition (TPN). It helps maintain sufficient serum levels of essential minerals and prevents deficiency symptoms and depletion of endogenous stores.
• Pharmacological Classification: Nutritional Supplement, Trace Element Supplement.
• Mechanism of Action: This combination provides essential trace elements required for various physiological functions. Chromium is involved in glucose metabolism and peripheral nerve function. Copper contributes to red and white blood cell formation. Manganese and selenium are essential cofactors for numerous enzymes and contribute to various metabolic processes.

Alternate Names

• Multitrace-5 Concentrate
• M.T.E.-6 Concentrated
• Celecel Injection
• Celecel 5 Injection 3 ml

How It Works

• Pharmacodynamics: Each component exerts specific effects: chromium supports insulin action and glucose metabolism; copper aids in hematopoiesis and iron transport; manganese supports enzyme function and bone health; and selenium acts as an antioxidant and supports thyroid hormone metabolism.
• Pharmacokinetics: Primarily administered intravenously, ensuring direct delivery into the bloodstream. Individual components have varying absorption, distribution, metabolism, and excretion profiles. Copper and manganese are eliminated via biliary excretion, while chromium and selenium have complex elimination pathways involving both renal and hepatic mechanisms.
• Mode of Action: Chromium enhances insulin receptor sensitivity, copper acts as a cofactor for enzymes involved in iron metabolism and hematopoiesis, manganese acts as a cofactor for enzymes like superoxide dismutase, and selenium is incorporated into selenoproteins with antioxidant and thyroid hormone-regulating properties.

Dosage

Standard Dosage

Adults: The recommended dosage varies based on individual needs and the specific product used. Typically, 10-15 mcg chromium, 0.5-1.5 mg copper, 0.15-0.8 mg manganese, and 20-40 mcg selenium per day are given intravenously as an additive to TPN solutions.

Children: Dosage is generally weight-based, typically 0.14-0.20 mcg/kg/day for chromium and 3 mcg/kg/day for selenium. Other trace element dosages are adjusted based on pediatric guidelines for TPN.

Special Cases:

• Elderly Patients: Dosage adjustments might be necessary based on kidney and liver function.
• Patients with Renal Impairment: Dose reduction or avoidance may be necessary, especially for chromium and selenium.
• Patients with Hepatic Dysfunction: Dose reduction or avoidance of copper and manganese may be required.
• Patients with Comorbid Conditions: Dosage individualization based on specific conditions and overall clinical status.

Clinical Use Cases

Primarily used as a supplement in TPN for patients unable to meet their nutritional needs through oral intake. Specific dosages for clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are determined by the patient’s overall nutritional requirements and clinical condition.

Dosage Adjustments

Dosage adjustments are made based on patient-specific factors, such as renal or hepatic dysfunction, metabolic disorders, or other clinical conditions. Monitoring of serum levels is essential to guide optimal therapy.

Side Effects

Common Side Effects

No common side effects have been reported with this combination at recommended dosages.

Rare but Serious Side Effects

Toxicity is rare at recommended dosages. Excessive intake of individual components can lead to specific toxicities: chromium (renal and hepatic damage, neurological abnormalities); copper (Wilson’s disease-like symptoms); manganese (neurotoxicity); selenium (seleniosis).

Long-Term Effects

Long-term use at excessive dosages may lead to cumulative toxicity of individual components.

Adverse Drug Reactions (ADR)

ADRs are rare at recommended doses. Allergic reactions to individual components are possible.

Contraindications

• Known hypersensitivity to any of the components.

Drug Interactions

• Antacids can reduce the absorption of trace elements; administer at least 2 hours apart.
• Interactions with specific medications are possible, especially for those affecting renal or hepatic function.

Pregnancy and Breastfeeding

• Pregnancy: Consult a doctor before use. While generally considered safe at recommended doses, the potential risks and benefits should be carefully evaluated.
• Breastfeeding: Consult a doctor before use. Data on excretion into breast milk are limited.

Drug Profile Summary

• Mechanism of Action: Provides essential trace elements for various physiological functions.
• Side Effects: Rare at recommended doses; potential toxicity with excessive intake of individual components.
• Contraindications: Hypersensitivity.
• Drug Interactions: Antacids, medications affecting renal/hepatic function.
• Pregnancy & Breastfeeding: Consult a doctor before use.
• Dosage: Individualized based on patient needs and product used. See detailed dosage section above.
• Monitoring Parameters: Serum levels of trace elements, renal and hepatic function tests.

Popular Combinations

Often included as part of a comprehensive TPN regimen that may include other vitamins, minerals, electrolytes, amino acids, and dextrose.

Precautions

• Monitor renal and hepatic function, especially with long-term use.
• Pre-screening for allergies to individual components.
• Adjust dosage in special populations.
• Monitor for signs of toxicity from individual components.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Chromium Chloride + Copper Sulphate + Manganese Sulphate + Selenious acid?

A: The recommended dosage varies depending on the specific product, patient age, and clinical condition. Refer to the detailed dosage guidelines provided above.

Q2: How is this combination administered?

A: It is typically administered intravenously as an additive to TPN solutions.

Q3: What are the signs of chromium toxicity?

A: Signs of chromium toxicity can include nausea, vomiting, gastrointestinal ulcers, renal and hepatic damage, and neurological abnormalities.

Q4: Are there any specific precautions for patients with liver disease?

A: Copper and manganese are eliminated via biliary excretion. Patients with liver disease may require dose reduction or avoidance of these trace elements.

Q5: Can this combination be used during pregnancy?

A: Consult a doctor before use during pregnancy. The risks and benefits should be carefully evaluated.

Q6: What are the potential drug interactions?

A: Antacids can reduce the absorption of trace elements. Other drug interactions are possible, particularly with medications affecting renal or hepatic function.

Q7: What are the monitoring parameters for this combination?

A: Monitor serum levels of trace elements, renal function tests, and hepatic function tests, especially with long-term use.

Q8: What is the role of each component in this combination?

A: Chromium supports glucose metabolism; copper aids in hematopoiesis and iron transport; manganese is involved in enzyme function and bone health; selenium acts as an antioxidant and supports thyroid function.

Q9: What should I do in case of a suspected overdose?

A: Seek immediate medical attention. Supportive care and management of specific toxicities based on the individual component are essential.

Q10: Can this medication be self-administered?

A: No, this medication should only be administered by a healthcare professional in a controlled medical setting, typically as part of a TPN regimen.