Trace Minerals

Diagnosis

Indications for Testing

• Patient with chronic illness, malabsorption, or postbariatric surgery
• Patients with known exposure (eg, industrial accident)

Laboratory Testing

• Order testing based on clinical scenario and/or presence of symptoms
  • Chromium, copper, selenium, zinc
  • Fasting serum or plasma testing – best reflects current nutritional status
  • Urine testing – may be useful for detecting exposures and for monitoring decontamination efforts
    • Not recommended for assessing current nutritional status

Screening

Clinical Background

The primary trace minerals of nutritional significance are chromium, copper, selenium, and zinc. Signs and symptoms of toxicity correlate with routes of exposure, specific elemental forms to which a person is exposed, and whether exposure is acute or chronic. Deficiencies of these minerals may exist in

•  Patients with
  • Chronic illness (eg, HIV)
  • Malabsorption syndrome
  • Unbalanced diet or parenteral nutrition
  • Pica
• Postbariatric surgery patients
• Preterm infants

Individual Trace Minerals

• Chromium

  Function – potentiates the action of insulin in patients with impaired glucose tolerance May also improve lipid profiles – proven in animal studies but not in humans Sources – yeast, meat, grain products 30 µg/day considered adequate Deficiency – impaired glucose tolerance Poor evidence, largely historical, very flawed studies Toxicity – dermatitis, renal failure, metal fume fever, pulmonary cancers (from chromium VI) Unknown outside of industrial exposures Recommended daily intake (RDI) – no need for chromium supplementation (FDA and American Diabetes Association)

  Copper

  Function – integral part of numerous enzyme systems including amine oxidase, ferroxidase, superoxide dismutase, dopamine hydroxylase Sources – shellfish, liver, nuts, legumes, bran, organ meats Deficiency –   anemia, osteopenia, degenerative changes in aortic elastin, growth retardation, hair pigment changes, cerebral and cerebellar degeneration (prototype is Menkes syndrome) Toxicity – nausea, emesis, diarrhea, hemolytic anemia, neurodegeneration, hepatic failure, Wilson disease Toxicity more likely at intake of 10 mg/day  RDI – 0.9 mg/day

  Selenium

  Function – component of the enzyme glutathione peroxidase Serves to protect proteins, cell membranes, lipids, and nucleic acids from oxidant molecules Sources – seafood, muscle meats, cereals Deficiency – cardiomyopathy and heart failure (Keshan disease), striated muscle degeneration, deforming arthritis (Kashin-Bek disease) Present in as many as 20% of patients postbariatric surgery Toxicity – alopecia, nausea, emesis, dermatitis Supplementation – recommended postbariatric surgery RDI – 35 µg/day

  Zinc

  Function – integral component of metalloenzymes Synthesizes and stabilizes proteins, DNA, and RNA Sources – meat, shellfish, nuts, legumes Deficiency – growth retardation, alopecia, dermatitis, diarrhea, failure to thrive, congenital malformations Toxicity – reduced copper absorption, gastritis, fever, nausea, emesis, metal fume fever 300-600 mg/day may induce sideroblastic anemia Supplementation – recommended with clinical management of childhood diarrhea RDI – 15 mg/day

Indications for Laboratory Testing

• Tests generally appear in the order most useful for common clinical situations
• Click on number for test-specific information in the ARUP Laboratory Test Directory

Click the plus sign to expand the table of additional tests.

Test Name and Number	Comments
Chromium, Urine 0025068 Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry	Not recommended for nutritional assessment
Copper, Urine 0020461 Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry	Not recommended for nutritional assessment
Selenium, Urine 0025067 Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry	Not recommended for nutritional assessment
Zinc, Urine 0020462 Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry	Not recommended for nutritional assessment