Usage
This combination of minerals is primarily used to treat or prevent deficiencies of chromium, copper, manganese, selenium, and zinc, especially in patients receiving total parenteral nutrition (TPN). These micronutrients are essential for various physiological functions. It is classified as a nutritional supplement.
Alternate Names
While this specific combination doesn’t have a unique international non-proprietary name (INN), it is sometimes referred to as “trace element supplement for parenteral nutrition.” Brand names include Trace I.V. Injection, Tracemax Injection, and Tracerise Injection. The individual components are also known by their chemical names: Chromium Chloride (CrCl3), Copper Sulphate (CuSO4), Manganese Sulphate (MnSO4), Selenium (Se), and Zinc Sulfate (ZnSO4).
How It Works
This combination provides essential trace elements crucial for enzymatic activities, metabolic processes, and cellular functions.
- Chromium: Enhances insulin action, influencing glucose metabolism, and supports peripheral nerve function.
- Copper: Essential for red and white blood cell formation, iron transport, and maintaining healthy nerves, blood vessels, bones, and the immune system.
- Manganese: Plays a role in enzyme activation, bone development, cholesterol, glucose, amino acid, and carbohydrate metabolism, blood clotting, and reducing inflammation.
- Selenium: Functions as an antioxidant, protecting cells from damage and the toxic effects of heavy metals and free radicals.
- Zinc: Supports immune function, cell growth, wound healing, gut health, and the senses of taste and smell. It also aids in insulin crystallization and release.
Pharmacokinetics: The absorption, distribution, metabolism, and excretion (ADME) vary for each mineral. Zinc and chromium are primarily excreted in urine; copper and manganese are mainly eliminated through bile; selenium is excreted via urine and feces.
Dosage
Dosages are individualized based on clinical condition and serum levels of each trace element. It’s administered intravenously after dilution in a compatible parenteral solution.
Standard Dosage
Adults:
- Zinc: 2.5-4 mg/day (increase to 2 mg/day in acute catabolic states or adjust further based on fluid loss).
- Copper: 0.5-1.5 mg/day.
- Manganese: 0.15-0.8 mg/day.
- Chromium: 10-15 mcg/day (increase to 20 mcg/day with intestinal fluid loss).
- Selenium: 20-40 mcg/day, or possibly up to 60mcg/day.
Children: Dosages are based on body weight and specific clinical guidelines (e.g., ASPEN).
- Zinc: Consult pediatric guidelines (<3 kg premature infants: 2-10 mcg/kg/day; infants and children: 0.2mcg/kg/day).
- Copper: 20-80 mcg/kg/day.
- Manganese: 2-10 mcg/kg/day.
- Chromium: 0.14-0.20 mcg/kg/day.
- Selenium: <3 kg premature infants: 1-3 mcg/kg/day; infants and children: 2-10 mcg/kg/day.
Special Cases:
- Elderly Patients: Adjust based on renal and hepatic function.
- Patients with Renal Impairment: Reduce dosage based on glomerular filtration rate, especially for chromium.
- Patients with Hepatic Dysfunction: Reduce dosage, especially for copper and manganese.
- Patients with Comorbid Conditions: Consider individual mineral needs and potential interactions.
Clinical Use Cases
The combination is generally used as a supplement during TPN in various clinical settings like:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
Dosage Adjustments
Adjustments are necessary based on renal/hepatic function, metabolic disorders, or other patient-specific factors influencing drug metabolism.
Side Effects
Side effects are typically mild and resolve upon discontinuation or dose adjustment of the specific mineral. Injection site reactions (pain, swelling, redness) are common.
Rare but Serious Side Effects
Toxicity can occur with excessive doses of individual components. Refer to individual mineral monographs for specific toxicities.
Contraindications
- Known hypersensitivity to any component.
- Conditions not requiring supplementation of all five trace elements.
Drug Interactions
- Antacids can reduce absorption of trace minerals.
- Interactions are possible with individual components and some medications (e.g., antibiotics, antihypertensives). Consult individual mineral monographs and drug interaction resources.
- Concomitant use of phosphorus-containing dairy products should be avoided or separated by at least 2 hours before/after zinc administration.
Pregnancy and Breastfeeding
- Pregnancy: Use with caution if benefits outweigh risks. Consult recommended daily allowances for each mineral.
- Breastfeeding: Exercise caution; the safety profile is not well-established.
Drug Profile Summary
This combination is not a single drug, so a comprehensive drug profile summary isn’t applicable. Refer to the individual component monographs for specific information.
Popular Combinations
These minerals are frequently found together in multivitamin/mineral supplements for TPN, but this precise formulation is not a recognized “popular combination” outside of its usage in TPN settings.
Precautions
Assess for pre-existing mineral imbalances or conditions that could be aggravated by supplementation. Specific age-related precautions exist for children and the elderly. For pregnant or breastfeeding women, use with caution if benefits outweigh potential risks.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chromium Chloride + Copper Sulphate + Manganese Sulphate + Selenium + Zinc Sulfate?
A: Dosages are individualized based on patient needs and serum levels. See “Dosage” section above for adult, pediatric, and special population guidelines.
Q2: How is this combination administered?
A: Intravenously, only after dilution in a compatible parenteral solution.
Q3: What are the primary uses of this combination?
A: Preventing and treating trace element deficiencies, especially in patients receiving TPN.
Q4: What are the common side effects?
A: Side effects are usually mild and resolve with discontinuation or dose adjustment. Injection site reactions may occur.
Q5: Are there any contraindications?
A: Yes, hypersensitivity to any component and conditions where supplementation of all five trace elements is not required.
Q6: Can this combination be used during pregnancy and breastfeeding?
A: Use with caution during pregnancy and breastfeeding if benefits outweigh risks. Data on pregnancy outcomes are limited.
Q7: What should be monitored during therapy?
A: Serum levels of each trace element should be monitored, along with relevant clinical parameters depending on the patient’s condition.
Q8: Are there any significant drug interactions?
A: Antacids may reduce absorption. Review concomitant medications for potential interactions with individual mineral components.
Q9: What precautions are necessary when prescribing this combination?
A: Assess for pre-existing mineral imbalances or medical conditions, and consider renal and hepatic function. Use cautiously in pregnant and breastfeeding women, children, and the elderly. Monitor for any adverse effects.
