trace metal combination additive

trace metal combination additive

,

Concentrated Multiple Trace Element

(trade name),

ConTE-PAK-4

(trade name),

M.T.E.-4

(trade name),

M.T.E.-4 Concentrated

(trade name),

M.T.E.-5

(trade name),

M.T.E.-5 Concentrated

(trade name),

M.T.E.-6

(trade name),

M.T.E.-6 Concentrated

(trade name),

M.T.E.-7

(trade name),

MulTE-PAK-4

(trade name),

MulTE-PAK-5

(trade name),

Multiple Trace Element

(trade name),

Multiple Trace Element Neonatal

(trade name),

Multiple Trace Element Pediatric

(trade name),

Neotrace 4

(trade name),

PedTE-PAK-4

(trade name),

Pedtrace-4

(trade name),

P.T.E.-4

(trade name),

P.T.E.-5

(trade name)

Classification

Therapeutic: mineral electrolyte replacements supplements
Pregnancy Category: C

Indications

Administered as a component in total parenteral nutrition (TPN, parenteral hyperalimentation).May contain any or all of the following:
  • Chromium,
  • Copper,
  • Iodine,
  • Manganese,
  • Molybdenum,
  • Selenium,
  • Zinc.

Action

Trace metals serve as cofactors or catalysts for numerous diverse homeostatic processes.

Therapeutic effects

Replacement in deficiency states when oral ingestion is not feasible.

Pharmacokinetics

Absorption: Administered IV only, resulting in complete bioavailability.Distribution: Widely distributed.Metabolism and Excretion: Excretion depends on individual trace element.Half-life: Unknown.

Time/action profile (replacement)

ROUTEONSETPEAKDURATION
IVrapidunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to iodine (iodine-containing products only).Use Cautiously in: Obstetric / Lactation: Pregnancy or lactation; NG suction, fistula drainage, prolonged vomiting or diarrhea (may increase requirements); Renal impairment or biliary obstruction (may increase risk of toxicity); Isolated trace element deficiency (other additives may be excessive—use only those required).

Adverse Reactions/Side Effects

Listed for individual trace metals—usually associated with toxicity

Miscellaneous

    Chromium:
  • coma (life-threatening)
  • seizures (life-threatening)
  • GI ulceration
  • hepatic damage
  • nausea
  • renal damage
  • vomiting
    • Copper:
  • behavioral changes
  • diarrhea
  • peripheral edema
  • photophobia
  • progressive marasmus
  • weakness
    • Iodine:
  • acneiform skin lesions
  • headache
  • increased salivation
  • metallic taste
  • parotitis
  • runny nose
  • sneezing
  • sore mouth
  • swelling of eyelids
    • Manganese:
  • anorexia
  • apathy
  • gait disturbances
  • headache
  • erectile dysfunction
  • irritability
  • speech difficulties
    • Molybdenum:
  • gout-like syndrome
    • Selenium:
  • garlic-like breath
  • garlic-like sweat
  • GI discomfort
  • hair loss
  • mental depression
  • metallic taste
  • nervousness
  • vomiting
  • weak nails
    • Zinc:
  • blurred vision
  • hypotension
  • jaundice
  • loss of consciousness
  • oliguria
  • pulmonary edema
  • tachycardia
  • toxicity poorly defined but may include hypothermia
  • vomiting

Interactions

Drug-Drug interaction

None significant in replacement doses.

Route/Dosage

Intravenous (Adults and Children) Amount necessary to maintain normal trace element levels.

Availability

All must be diluted in large-volume parenterals prior to useInjection: Each mL contains 0.85–4 mcg chromium, 0.1–0.4 mg copper, 0.025–0.16 mg manganese, and 0.5–1.5 mg zinc. Some products also contain iodide, selenium, and molybdenum Concentrated injection: Each mL contains 10 mcg chromium, 1 mg copper, 0.5 mg manganese, and 5 mg zinc. Some products also contain iodide and selenium

Nursing implications

Nursing assessment

  • Assess nutritional status by 24-hr recall prior to therapy.
  • Monitor patient for signs and symptoms of trace metal deficiencies prior to and throughout therapy, as follows:.
  • Chromium—glucose intolerance, ataxia, peripheral neuropathy, confusion.
  • Copper—leukopenia, neutropenia, anemia, iron deficiency, skeletal abnormalities, defective tissue formation.
  • Iodine—impaired thyroid function, goiter, cretinism.
  • Manganese—nausea, vomiting, weight loss, dermatitis, changes in hair.
  • Molybdenum—tachycardia, tachypnea, headache, night blindness, nausea, vomiting, edema, lethargy, disorientation, coma, hypouricemia, hypouricosuria.
  • Selenium—cardiomyopathy, muscle pain, kwashiorkor, Keshan disease.
  • Zinc—diarrhea, apathy, depression, anorexia, hypogonadism, growth retardation, anemia, hepatosplenomegaly, impaired wound healing, decreased sense of taste and smell.
  • Lab Test Considerations: Serum trace metal concentrations should be monitored periodically throughout TPN therapy.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)

Implementation

  • Intravenous Administration
  • Intravenous: Solution usually does not contain preservatives; discard unused portion.
  • Continuous Infusion: Diluent: Must be diluted prior to administration. Dilute each dose in at least 1 liter of IV solution.
  • Rate: Administer at prescribed rate for TPN infusion.
  • Additive Compatibility: Usually compatible with other trace metals, electrolytes, and dextrose/amino acid combinations used for TPN.

Patient/Family Teaching

  • Explain purpose of infusion of TPN and components to patient.

Evaluation/Desired Outcomes

  • Prevention or treatment of trace metal deficiencies.