Important Facts TABLE 2. DAILY TE REQUIREMENTS FOR PEDIATRIC AND NEONATAL PATIENTS Adolescents About Parenteral Term Neonates Children Greater Trace Element Preterm Neonates 3-10 kg 10-40 kg than 40 kg Zinc 400 mcg/kg 250 mcg/kg 50 mcg/kg 2-5 mg (max 5000 (Selenious Acid) mcg/d) Copper 20 mcg/kg 20 mcg/kg 20 mcg/kg 200-500 mcg Who needs selenium in their (max 500 (PN)? mcg/d) Manganese 1 mcg/kg 1 mcg/kg 1 mcg/kg 40-100 mcg ASPEN recommends that selenium be (max 55 mcg/d) routinely added to PN formulations, either in a multiple trace element (TE) Chromium 0.05-0.3 mcg/ 0.2 mcg/kg 0.2 mcg/kg 5-15 mcg product (if available) or as a separate kg (max 5 mcg/d) entity.1 Selenium is not included in any pediatric or neonatal multiple TE Selenium 2 mcg/kg 2 mcg/kg 2 mcg/kg 40-60 mcg (max 100 products currently available in the mcg/d) U.S. Specifically, use with patients on *Note: These requirements are different than the multi-trace element products currently available in the US. PN who are NPO and/or cannot ingest or absorb nutrients via their GI tract. What is the role/function of Recommendations Which products include parenteral selenium? It is not recommended to decrease selenium? Selenium is an essential nutrient that or exclude the dose of selenious acid • Adult multi-trace element products serves important functions including in PN due to cost or access to the • Selenious acid injection antioxidative defense through actions product such as reducing the nutrient of peroxidase, an enzyme to only three times per week. How much selenium do patients that catalyzes the breakdown of receiving PN need? hydroperoxides and has metabolic Monitor trace element levels in long interrelationships with E, an term parenteral nutrition patients. TABLE 1. DAILY TE REQUIREMENTS FOR . It also participates in ADULTS enzymatic conversion of thyroxine References Standard Daily to its more active metabolite, tri- 1. Vanek VW, Borum P, Buchman A, et al. Trace Element Requirement iodothyronine and is a cofactor for A.S.P.E.N. position paper: recommenda- Chromium <1 mg 1 tions for changes in commercially available protein and DNA synthesis. parenteral multivitamin and multi–trace Copper 0.3-0.5 mg element products. Nutr Clin Pract. 2012; Manganese 55 mcg What does a selenium deficiency 27(4):440-491. look like? Selenium 60-100 mcg 2. Vanek VW, Borum P, Buchman A, et al. A call of selenium to action to bring safer parenteral micronu- Zinc 3-5 mg trient products to the U.S. market. Nutr Clin deficiency include cardiomyopathy, Pract. 2015; 30(4): 559–569. * Prescribe full daily dose unless patient able to myalgias, myositis, anemia, ingest or absorb orally/enterally. 3. Jensen GL and Binkley J. Clinical manifesta- Note: These requirements are different than the hemolysis, and impaired cellular tions of nutrient deficiency. JPEN J Parenter multi-trace element products currently available in the US. immunity. is Enteral Nutr. 2002; 26:S29-S33. an endemic cardiomyopathy 4. Shenkin A. Selenium in intravenous nutrition. associated with selenium deficiency Gastroenterology. 2009; 137:S61-S69. in China.1-4

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