Maintenance of Vitamin and Trace Element Status in Intravenous Nutrition using a Complete Nutritive Mixture

TLDR

Complete nutritive mixtures (CNM) are increasingly used for intravenous nutrition, but they may cause chemical interactions that reduce the availability of active vitamins and trace elements. In a study of 10 postoperative patients, researchers compared a single 3‑liter CNM bag containing amino acids, dextrose, Intralipid 20%, a nine‑element trace metal mix, and full vitamin blends to a separate infusion of fat emulsion plus water‑ and fat‑soluble vitamins, measuring serum and urine levels of multiple minerals and vitamins weekly. Both groups maintained or improved micronutrient status, with no significant differences in blood concentrations; only CNM increased urine copper excretion, suggesting a possible interaction, but overall micronutrient status was preserved without greater loss. Journal of Parenteral and Enteral Nutrition 11: 238–242, 1987.

Abstract

Complete nutritive mixtures (CNM) of all intravenous nutrients including fat emulsions are being used increasingly because of their convenience. However, this may lead to chemical interactions and reduce the amount of active vitamins and trace elements made available to the patient. We have studied the effects on micronutrient status of provision of all nutrients in one 3‐liter bag (CNM: amino acids, dextrose, Intralipid 20%, a nine‐element trace metal mixture, and complete fat‐ and water‐soluble vitamin mixtures) in 10 postoperative surgical patients [median intravenous nutrition (IVN) 14.5 days, range 7–38]. A similar group received the fat emulsion plus water‐ and fat‐soluble vitamins as a separate infusion (SI) from a 3‐liter bag (median IVN 14.0 days, range 8–28). Serum and urine magnesium, zinc, copper, manganese, chromium, and selenium, serum vitamins A, E, C, folate, and B 12 , RBC B 1 , B 2 B 6 , and folate and leukocyte vitamin C were measured at weekly intervals. All patients in both groups maintained or improved their status for all the micronutrients analyzed. No significant differences between the CNM and SI groups were found in blood concentrations of any of the elements or vitamins. Only for urine copper did the CNM lead to increased excretion (1.51 ± 0.59 μ mol/24 hr; copper input 20 μ mol/day), compared to SI (1.00 ± 0.70 μ mol/day, p < 0.001 Mann‐Whitney test) suggesting possible interaction. It is concluded that micronutrient status was maintained during short‐term IVN with the CNM and that it did not lead to a significantly greater loss of vitamins or essential trace elements than the SI system. (Journal of Parenteral and Enteral Nutrition 11: 238–242, 1987)