Trace Mineral Intake Zinc –4 mg/d, an additional 10–15 mg/d per L of stool or ileostomy output Copper – mg/d, possibility of retention in biliary tract obstruction Manganese – mg/d, possibility of retention in biliary tract obstruction Chromium 10–15 µg/d Selenium 20–100 µg/d, necessary for long-term PN, optional for short-term TPN Molybdenum 20–120 µg/d, necessary for long-term PN, optional for short-term PN Iodine 75–150 µg/d, necessary for long-term PN, optional for short-term PN a Commercial products are available that have the first four, first five, and all seven of these metals in recommended amounts. Note: PN, parenteral nutrition; TPN, total parenteral nutrition. . | Chapter 073. Enteral and Parenteral Nutrition Part 8 Table 73-6 Parenteral Trace Metal Supplementation for Adults Trace Mineral Intake Zinc mg d an additional 10-15 mg d per L of stool or ileostomy output Copper mg d possibility of retention in biliary tract obstruction Manganese mg d possibility of retention in biliary tract obstruction Chromium 10-15 pg d Selenium 20-100 pg d necessary for long-term PN optional for short-term TPN Molybdenum 20-120 pg d necessary for long-term PN optional for short-term PN Iodine 75-150 pg d necessary for long-term PN optional for short-term PN Commercial products are available that have the first four first five and all seven of these metals in recommended amounts. Note PN parenteral nutrition TPN total parenteral nutrition. Parenteral Nutrition Infusion Technique and Patient Monitoring Parenteral feeding through a peripheral vein is limited by osmolality and volume constraints. Solutions that contain more than 3 amino acids and 5 glucose 290 kcal L are poorly tolerated peripherally. Parenteral fat 20 can be given to increase the calories delivered. The total volume required to provide a marginal protein intake of 60 g and 1680 total kcal is L. However the risk of significant morbidity and mortality from incompatibilities of calcium and phosphate salts is greatest in these low-osmolality low-glucose regimens. Parenteral feeding via a peripheral vein is generally intended as a supplement to oral feeding and is not optimal for the critically ill. Peripheral parenteral nutrition may benefit from small amounts of heparin at 1000 U L and co-infusion with parenteral fat to reduce osmolality but volume constraints still limit the value of this therapy. Peripherally inserted central catheters PICCs can be used for the short term to provide concentrated glucose parenteral solutions of 20-25 dextrose and 4-7 amino acids while avoiding some of the complications of catheter placement via a large central vein. With .
