trace metal combination additive(redirected from MulTE-PAK-4)
trace metal combination additive,
Concentrated Multiple Trace Element(trade name),
M.T.E.-4 Concentrated(trade name),
M.T.E.-5 Concentrated(trade name),
M.T.E.-6 Concentrated(trade name),
Multiple Trace Element(trade name),
Multiple Trace Element Neonatal(trade name),
Multiple Trace Element Pediatric(trade name),
Neotrace 4(trade name),
Pregnancy Category: C
ClassificationTherapeutic: mineral electrolyte replacements supplements
Administered as a component in total parenteral nutrition (TPN, parenteral hyperalimentation).May contain any or all of the following:
Trace metals serve as cofactors or catalysts for numerous diverse homeostatic processes.
Replacement in deficiency states when oral ingestion is not feasible.
Absorption: Administered IV only, resulting in complete bioavailability.
Distribution: Widely distributed.
Metabolism and Excretion: Excretion depends on individual trace element.
Time/action profile (replacement)
Contraindicated in: Hypersensitivity to iodine (iodine-containing products only).
Use Cautiously in: Obstetric / Lactation: Pregnancy or lactation; NG suction, fistula drainage, prolonged vomiting or diarrhea (may increase requirements); Renal impairment or biliary obstruction (may increase risk of toxicity); Isolated trace element deficiency (other additives may be excessive—use only those required).
Adverse Reactions/Side EffectsListed for individual trace metals—usually associated with toxicity
- coma (life-threatening)
- seizures (life-threatening)
- GI ulceration
- hepatic damage
- renal damage
- vomiting Copper:
- behavioral changes
- peripheral edema
- progressive marasmus
- weakness Iodine:
- acneiform skin lesions
- increased salivation
- metallic taste
- runny nose
- sore mouth
- swelling of eyelids Manganese:
- gait disturbances
- erectile dysfunction
- speech difficulties Molybdenum:
- gout-like syndrome Selenium:
- garlic-like breath
- garlic-like sweat
- GI discomfort
- hair loss
- mental depression
- metallic taste
- weak nails Zinc:
- blurred vision
- loss of consciousness
- pulmonary edema
- toxicity poorly defined but may include hypothermia
Drug-Drug interactionNone significant in replacement doses.
Intravenous (Adults and Children) Amount necessary to maintain normal trace element levels.
AvailabilityAll must be diluted in large-volume parenterals prior to use
Injection: Each mL contains 0.85–4 mcg chromium, 0.1–0.4 mg copper, 0.025–0.16 mg manganese, and 0.5–1.5 mg zinc. Some products also contain iodide, selenium, and molybdenum
Concentrated injection: Each mL contains 10 mcg chromium, 1 mg copper, 0.5 mg manganese, and 5 mg zinc. Some products also contain iodide and selenium
- Assess nutritional status by 24-hr recall prior to therapy.
- Monitor patient for signs and symptoms of trace metal deficiencies prior to and throughout therapy, as follows:.
- Chromium—glucose intolerance, ataxia, peripheral neuropathy, confusion.
- Copper—leukopenia, neutropenia, anemia, iron deficiency, skeletal abnormalities, defective tissue formation.
- Iodine—impaired thyroid function, goiter, cretinism.
- Manganese—nausea, vomiting, weight loss, dermatitis, changes in hair.
- Molybdenum—tachycardia, tachypnea, headache, night blindness, nausea, vomiting, edema, lethargy, disorientation, coma, hypouricemia, hypouricosuria.
- Selenium—cardiomyopathy, muscle pain, kwashiorkor, Keshan disease.
- Zinc—diarrhea, apathy, depression, anorexia, hypogonadism, growth retardation, anemia, hepatosplenomegaly, impaired wound healing, decreased sense of taste and smell.
- Lab Test Considerations: Serum trace metal concentrations should be monitored periodically throughout TPN therapy.
Potential Nursing DiagnosesImbalanced nutrition: less than body requirements (Indications)
- Intravenous: Solution usually does not contain preservatives; discard unused portion.
- Continuous Infusion: Diluent: Must be diluted prior to administration. Dilute each dose in at least 1 liter of IV solution.
- Rate: Administer at prescribed rate for TPN infusion.
- Additive Compatibility: Usually compatible with other trace metals, electrolytes, and dextrose/amino acid combinations used for TPN.
- Explain purpose of infusion of TPN and components to patient.
- Prevention or treatment of trace metal deficiencies.