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Multi-Trace Elements (Adult)

Drug Class: Vitamins and Minerals
Dosage Form: Injection
Strength: 5 elements Each mL contains: Zinc Sulfate Heptahydrate 4.39mg (equivalent to 1mg Zinc) + Cupric Sulfate Pentahydrate 1.57mg (equivalent to 0.4mg Copper) + Manganese Sulfate Monohydrate 0.308mg (equivalent to 0.1mg Manganese) + Chromic Chloride Hexahydrate 20.5mcg (equivalent to 4mcg Chromium) + Selenious Acid 32.7mcg (equivalent to 20mcg Selenium) in Water for Injection.
Indications/Special comments: This formulation is indicated for use as a supplement to intravenous solutions given for TPN. Administration of the solution in TPN solutions helps to maintain plasma levels of zinc, copper, manganese, selenium and chromium and to prevent depletion of endogenous stores of these trace elements and subsequent deficiency symptoms.
Dosage Administration: The suggested dosage ranges for the five trace elements are: Zinc: For the metabolically stable adult receiving TPN, the suggested intravenous dosage level is 2.5 to 4mg zinc/day. An additional 2mg zinc/day is suggested for acute catabolic states. For the stable adult with fluid loss from the small bowel, an additional 12.2mg zinc/liter of small bowel fluid lost, or an additional 17.1mg zinc/kg of stool or ileostomy output is recommended. Frequent monitoring of zinc blood levels is suggested for patients receiving more than the usual maintenance dosage level of zinc. Normal plasma levels for zinc vary from approximately 88 to 112mcg/100mL. For full term infants and children up to 5 years of age, 100mcg zinc/kg/day is recommended. For premature infants (birth weight less than 1500g) up to 3kg in body weight, 300mcg zinc/kg/day is suggested. Copper: For the metabolically stable adult receiving TPN, the suggested additive dosage level is 0.5 to 1.5mg copper/day. For paediatric patients, the suggested additive dosage level is 20mcg copper/kg/day. The normal plasma range for copper is approximately 80 to 160mcg/100mL. Manganese: For the metabolically stable adult receiving TPN, the suggested additive dosage level for manganese is 0.15mg to 0.8mg/day. For paediatric patients, a dosage level of 2 to 10mcg manganese/kg/day is recommended. Chromium: For the metabolically stable adult receiving TPN, the suggested additive dosage level is 10 to 15mcg chromium/day. The metabolically stable adult with intestinal fluid loss may require 20mcg chromium/day, with frequent monitoring of blood levels as a guideline for subsequent administration. For paediatric patients, the suggested additive dosage level is 0.14 to 0.20mcg/kg/day. Selenium: For metabolically stable adults receiving TPN, the suggested additive dosage level is 20 to 40 mcg selenium/day. For paediatric patients, the suggested additive dosage level is 3mcg/kg/day. In adults, selenium deficiency states resulting from long term TPN support, selenium as selenomethionine or selenious acid, administered intravenously at 100mcg/day for a period of 24 and 31 days, respectively, has been reported to reverse deficiency symptoms without toxicity. The normal whole blood range for selenium is approximately 10 to 37mcg/100mL.