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Pharmaceutisch weekblad

, Volume 1, Issue 1, pp 1307–1322 | Cite as

Spoorelementen met betrekking tot parenterale voeding

  • A. P. Labruyère
Voordrachten

Samenvatting

Deficiëntieverschijnselen tijdens parenterale voeding zijn beschreven voor zink, koper en chroom. Naast verlaagde plasmaspiegels zijn de eerste tekenen bij zinkgebrek diarree en specifieke huidafwijkingen, bij kopertekort neutropenie, leukopenie en anemie, en bij chroomdeficiëntie glucose-intolerantie. Ter preventie zou men tijdens de parenterale voeding spoorelementen extra moeten toedienen. Aangezien de voedingsoplossingen reeds met spoorelementen zijn gecontamineerd, begint de suppletie eigenlijk al bij aanvang van de intraveneuze voeding, echter in gewoonlijk onbekende hoeveelheden. Geadviseerd wordt om zink direct bij aanvang van de parenterale voeding te suppleren; koper na 2 maanden — of eerder — wanneer de koperspiegel in het plasma daalt; mangaan na ca. 2 maanden, en chroom na ca. 3 maanden. Aanbevolen hoeveelheden voor intraveneuze suppletie bij volwassenen en kinderen worden gegeven. Ook suppletie van ijzer, kobalt (als vitamine B12) en jood is aangewezen.

De contaminatie van injectievloeistoffen wordt geÏllustreerd aan de hand van een onderzoek naar het voorkomen van zink, koper, mangaan, ijzer, seleen en arseen in enige oplossingen. De toxiciteit van een aantal elementen wordt besproken.

Tot besluit wordt het ziekteverloop van een parenteraal gevoede patiënte beschreven, bij wie geen suppletie van spoorelementen plaatsvond.

Trace elements in parenteral nutrition

Abstract

Deficiency symptoms in parenteral nutrition have been described for zinc, copper and chromium. In addition to reduced plasma levels the first signs in zinc deficiency are diarrhoea and specific skin lesions; in copper deficiency neutropenia, leucopenia and anemia, and in chromium deficiency glucose intolerance. Deficiencies may be prevented by adding trace elements to parenteral solutions. Alimentation solutions are in fact contaminated with trace elements, so that suppletion starts at initiation of parenteral nutrition; the amounts however are usually unknown. Zinc should be added to intravenous solutions at the beginning of parenteral nutrition; copper after 2 months, and sooner when copper plasma levels are reduced; manganese 2 months and chromium about 3 months after starting intravenous nutrition. Recommendations for intravenous intakes of trace elements for adults and infants are given. Iron, cobalt (as vitamin B12) and iodine should also be supplied. Contamination of parenteral solutions is illustrated by the results of zinc, copper, manganese, iron, selenium and arsenic determinations in some solutions.

Toxicity of several elements is discussed. The course of disease in a patient receiving parenteral nutrition without trace element suppletion is described.

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Copyright information

© Bohn, Scheltema & Holkema 1979

Authors and Affiliations

  • A. P. Labruyère
    • 1
  1. 1.Apotheek Stichting Ziekenhuis Venlo-TegelenVenlo

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