|Nielsen, Forrest - Frosty|
Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 12/1/2005
Publication Date: 3/1/2006
Citation: Klein, C.J., Nielsen, F.H., Moser-Veillon, P.B. 2006. Trace element loss following trauma and during continuous renal replacement therapy [abstract]. Journal of Parenteral and Enteral Nutrition. 30(2):536-7. Interpretive Summary:
Technical Abstract: Background and Purpose: Limited data are available to establish trace element recommendations during critical care. The purpose of this study was to quantify the urinary loss of boron, manganese, nickel, silicon, and selenium following traumatic injury as well as loss in effluent during continuous renal replacement therapy (CRRT). Where possible, loss relative to intake of trace elements was evaluated to assess the adequacy of total parenteral nutrition (TPN). Methods: Twelve adult male trauma patients receiving TPN were grouped by renal status: adequate function (POLY; n=6), acute failure with hemofiltration (CVVH; n=2), or hemodiafiltration (CVVHD; n=4). Urine was collected hourly for up to 72 consecutive hours and pooled to create 24-hr collections for each patient. All effluent draining from artificial kidney filters was collected hourly for up to 72 consecutive hours and a proportionate sample (1/1000 by weight) from each hour was pooled to create 24-hr collections for each patient. TPN prescriptions and actual volumes delivered were recorded. Samples of dialysate and other samples were analyzed for boron, manganese, nickel, and silicon using inductively coupled plasma atomic emission spectrometry and were analyzed for selenium using atomic absorption spectrometry. Results: All patients received TPN compounded with 300 µg/d manganese (as sulfate) and 60 µg/d selenium (as selenious acid) with no added supplements of boron, nickel, or silicon. All POLY patients excreted greater than 2.5 L/d urine on one or more study days. Daily loss of trace elements is presented in the Table. Boron, manganese, nickel, and silicon were detected in dialysate (prior to use) whereas selenium (0.10 ng/mL detection limit) was not. CRRT patients lost greater amounts of boron, manganese, nickel and silicon but less selenium than POLY patients. Nickel in CVVHD effluent was seven times the amount in CVVH ultrafiltrate.