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Digestive Diseases and Sciences

, Volume 31, Issue 6, pp 661–664 | Cite as

Chromium deficiency after long-term total parenteral nutrition

  • Rex O. Brown
  • Sue Forloines-Lynn
  • Robert E. Cross
  • William D. Heizer
Case Report

Summary

A 63-year-old female developed unexplained hyperglycemia and glycosuria during administration of a total parenteral nutrition regimen on which she had been stable for several months. Because the patient had no history of diabetes or evidence of an infection, chromium deficiency was considered. Plasma chromium level was 0.1 μg/dl (laboratory reference interval: 1.8–3.8 μg/dl). Fourteen days of supplemental intravenous chromium chloride (200 μg/day) allowed complete withdrawal of exogenous insulin with no further hyperglycemia or glycosuria. Correction of unexplained glucose intolerance following vigorous chromium supplementation indicates that the patient had chromium deficiency. Subsequent plasma chromium levels remained unchanged, possibly reflecting the sensitivity limits of the assay that was used, the uncertainty that exists regarding appropriate reference intervals for this element, and the fact that plasma levels do not always correlate with total body stores. The patient did not manifest peripheral neuropathy, which was present in one of the two previously reported cases, nor encephalopathy, which was reported in the other. We conclude that this patient developed chromium deficiency as a result of inadequate administration of chromium in the parenteral formula (6 μg/day) plus excessive enteric losses, and she presented with glucose intolerance as the only clinical manifestation of the deficiency. Caution should be exercised when interpreting plasma chromium in patients with suspected deficiency.

Keywords

Chromium Hyperglycemia Peripheral Neuropathy Glucose Intolerance Total Parenteral Nutrition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Schwarz IK, Mertz W: Chromium (III) and the glucose tolerance factor. Arch Biochem Biophys 85:292–295, 1959Google Scholar
  2. 2.
    Hambridge KM: Chromium nutrition in man. Am J Clin Nutr 27:505–514, 1974Google Scholar
  3. 3.
    Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg GR, Bruce-Robertson A: Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am J Clin Nutr 30:531–538, 1977Google Scholar
  4. 4.
    Freund H, Atamian S, Fischer JE: Chromium deficiency during total parenteral nutrition. JAMA 241:496–498, 1979Google Scholar
  5. 5.
    Anderson RA, Polansky MM, Bryden NA, Roginski EE, Patterson KY, Veillon C, Glinsmann W: Urinary chromium excretion of human subjects: Effects of chromium supplementation and glucose loading. Am J Clin Nutr 36:1184–1193, 1982Google Scholar
  6. 6.
    Versieck J, Hoste J, Barbie F, Steyaert H, DeRudder J, Michels H: Determination of chromium and cobalt in human serum using neutron activation analysis. Clin Chem 24:303–308, 1978Google Scholar
  7. 7.
    Stitch SR: Trace elements in human tissue. Biochem J 67:97–103, 1957Google Scholar
  8. 8.
    Phillips GD, Garnys VP: Trace element balance in adults receiving parenteral nutrition: Preliminary data. J Parentr Enter Nutr 5:11–14, 1981Google Scholar
  9. 9.
    Anonymous: Guidelines for essential trace element preparations for parenteral use. JAMA 241:2051–2054, 1979Google Scholar
  10. 10.
    Davis JM, Illner H, Dineen P: Increased chromium uptake in polymorphonuclear leukocytes from burned patients. J Trauma 24:1003–1009, 1984Google Scholar
  11. 11.
    Wolman SL, Anderson GH, Marliss EB, Jeejeebhoy KN: Zinc in total parenteral nutrition: Requirements and metabolic effects. Gastroenterology 76:458–467, 1979Google Scholar

Copyright information

© Plenum Publishing Corporation 1986

Authors and Affiliations

  • Rex O. Brown
    • 1
    • 2
    • 3
  • Sue Forloines-Lynn
    • 1
    • 2
    • 3
  • Robert E. Cross
    • 1
    • 2
    • 3
  • William D. Heizer
    • 1
    • 2
    • 3
  1. 1.Department of Clinical Pharmacy, College of PharmacyUniversity of Tennessee Center for the Health SciencesMemphis
  2. 2.Department of PharmacyNorth Carolina Memorial HospitalChapel Hill
  3. 3.Department of Pathology, and Department of MedicineUniversity of North CarolinaChapel Hill

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