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01-05-2018 | What's New in Intensive Care

What’s new in trace elements?

Authors: Pierre Singer, William Manzanares, Mette M. Berger

Published in: Intensive Care Medicine | Issue 5/2018

Excerpt

Trace elements (TE), namely selenium (Se), zinc (Zn), copper (Cu), iodine (I), molybdenum (Mo), chromium (Cr), iron (Fe), and manganese (Mn), are essential in daily nutritional care of the critically ill [1] and should be administered daily (normal values are presented in Table 1). Their deficiency may be lethal if uncorrected. Because of their potential antioxidant functions [2], TE have been administered alone or in association, sometimes at high doses, in specific critical conditions, to improve outcome. Special conditions such as burns, fistulas, or renal replacement therapy involve large losses and have specific requirements. Special needs/utilization of TE are discussed.

Table 1

Plasma level of Se (selenium), Zn (zinc), Cu (copper), and Fe (iron) in various clinical conditions and their known association with outcome

Conditions	Se	Zn	Cu	Fe	Outcome if administrated and references
RDI	60 μg	8–10 mg	1 mg	0.5 mg	RDI
Sepsis	Low	Decrease		Low	− [3]
Burns	Low	Low +++	Low ++	Low	+ [12]
AKI/CRRT	Low	Decrease	Low		+ [11]
Cardiovascular	Decrease after surgery Check if severe CHF	Decrease after surgery	Decrease after surgery		− [6]
Liver failure					Do not administer Cu
Bariatric surgery		37% of patients decrease	10% of patients decrease	5–42% low	+ [14]

RDI recommended daily intravenous intake, AKI acute kidney injury, CRRT continuous renal replacement therapy, CHF congestive heart failure

…

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Litton E, Baker S, Erber WN, Farmer S, Ferrier J, French C et al (2016) Intravenous iron or placebo for anemia in intensive care: the IRONMAN multicentre randomized blinded trial: a randomized trial of IV iron in critical illness. Intensive Care Med 42:1715–1722CrossRefPubMed

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11.

Tonelli M, Wiebe N, Thompson S, Kinniburgh D, Klarenbach SW, Walsh M et al (2015) Trace element supplementation in hemodialysis patients: a randomized controlled trial. BMC Nephrol 16:52CrossRefPubMedPubMedCentral

12.

Ben-Hamouda N, Charrière M, Voirol P, Berger MM (2017) Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement. Nutrition 34:71–75CrossRefPubMed

13.

Jafari P, Thomas A, Haselbach D, Wafta W, Pantet O, Michetti M, et al (2017) Trace element intakes should be revisited in burn nutrition protocols: a cohort study. Clin Nutr. doi:10.1016/j.clnu.2017.03.028

14.

Rousseau AF, Losser MR, Ichai C, Berger MM (2013) ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr 32:497–502CrossRefPubMed

15.

Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG (2017) Micronutrient deficiency after bariatric surgery: an emphasis on vitamins and trace minerals. Nutr Clin Pract 32(4):471–480

16.

Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L (2017) American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis 13:727–741CrossRefPubMed

Title: What’s new in trace elements?
Authors: Pierre Singer
William Manzanares
Mette M. Berger
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4955-1

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