Daily intravenous needs of some essential trace elements.

Trace element	Infants weighing <2.5 kg	Older children
Zinc	100-400 µg/kg	4,000 µg
Copper	10-40 µg/kg	1,600 µg
Chromium	0.1-0.4 µg/kg	16 µg
Manganese	2.5-10.0 µg/kg	400 µg
Selenium	1.5-2.0 µg/kg	8 µg

                           

Monitoring of total parenteral nutrition (TPN).

	Neonate		Child/Adolescent
	Initial*	Subsequently	Initial*	Subsequently
Strict I/O	Daily	Daily	Daily	Daily
Urinary glucose	Every void	Every shift	Every void	Every shift
Electrolytes, BUN	2-3 times per week	Every week	2-3 times per week	Every week
Ca, P, Mg	Every week	Every other week	2 times per week	Every week
Alkaline phosphatase, albumin	None	Every other week	Every week	Every other week
Triglycerides	4 h post initial infusion	With each change	4 h post initial infusion	With each change
Prealbumin	See below		See below

*First 3-7 days, depending on the patient's stabilityI/O = input and output; BUN = blood urea nitrogen

Prealbumin: Test 24-48 h post TPN initiation to assess adequacy of protein intake. Monitor with any change in status or protein intake, or to assess adequacy of intake. May be falsely elevated with renal disease.

Triglycerides:  If greater than 150 mg/dl (2 mmol/l), halve rate of infusion and retest to assess tolerance. Lipoprotein lipase is an inducible enzyme and tolerance to lipids will generally improve with time. Check baseline triglycerides in septic patients and in those with pancreatitis, renal disease, or diabetes. If markedly elevated, contact the Nutrition Support Team.

Ionized calcium: Check when serum calcium levels are altered by low albumin.

Zinc: Zinc status should be assessed in patients with increased gastrointestinal losses, inflammatory bowel disease, cystic fibrosis, or fistulas.

Transaminases/bilirubin: Check monthly with patients on long-term TPN (greater than 2 weeks) or TPN-dependent patients.