chromium chloride + copper gluconate + ferrous gluconate + manganese gluconate + potassium iodide + sodium fluoride + sodium molybdate + sodium selenite + zinc gluconate: clinical use

Prescribing considerations

• Confirm adult parenteral nutrition requirements and review clinical and biochemical parameters.
• Consider reduced biliary excretion, renal or hepatic impairment, repeated transfusions, insulin-treated diabetes, thyroid disease and known allergies.
• Longer-term parenteral nutrition may still cause iron, zinc or selenium deficiency requiring individual assessment.

Contraindications and cautions

• Children and adolescents.
• Pronounced cholestasis.
• Hypersensitivity to an active substance or excipient.
• Wilson's disease or haemochromatosis.
• An elevated serum concentration of any included trace element.

Monitoring

• Relevant serum trace-element concentrations.
• Manganese during prolonged artificial nutrition.
• Renal and hepatic function and evidence of cholestasis.
• Blood glucose in insulin-treated diabetes.
• Iron status and overload risk after repeated blood transfusions.
• Iron, zinc and selenium during medium- or long-term parenteral nutrition.

Clinical pharmacology

A balanced nine-element solution supporting metabolic equilibrium. Iron, copper, manganese and zinc are eliminated mainly through bile; iodine, fluoride, molybdenum, selenium and chromium rely substantially on renal elimination.

Formulation and product differences

• Adult-only concentrate requiring dilution or mixing before infusion.
• Clear, slightly yellow solution containing hydrochloric acid for pH adjustment and water for injections.
• Essentially sodium-free and potassium-free.
• Incompatible with direct addition to inorganic phosphate solutions; compatibility with the complete nutrition mixture must be established.