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Correlation of Cholestasis With Serum Copper and Whole-Blood Manganese Levels in Pediatric Patients
Many institutions reduce or eliminate copper (Cu) and manganese (Mn) in parenteral nutrition (PN) solutions when cholestasis develops. Little data exist to support this practice. Fifty-four subjects with known serum Cu, whole-blood Mn, and serum-conjugated bilirubin levels were evaluated in this pro...
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| Published in: | Nutrition in clinical practice 2008-04, Vol.23 (2), p.161-165 |
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| cites | cdi_FETCH-LOGICAL-c3811-4159f23255eb6fe51197f34bc05ed4cddfd5a13699c74e63a27287c5521d3f183 |
| container_end_page | 165 |
| container_issue | 2 |
| container_start_page | 161 |
| container_title | Nutrition in clinical practice |
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| creator | McMillan, Nancy B. Mulroy, Cecilia MacKay, Mark W. McDonald, Catherine M. Jackson, W. Daniel |
| description | Many institutions reduce or eliminate copper (Cu) and manganese (Mn) in
parenteral nutrition (PN) solutions when cholestasis develops. Little data
exist to support this practice. Fifty-four subjects with known serum Cu,
whole-blood Mn, and serum-conjugated bilirubin levels were evaluated in this
prospective, observational study. Subjects ranged in weight from 760 g to 65.2
kg. Subjects weighing |
| doi_str_mv | 10.1177/0884533608314529 |
| format | article |
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parenteral nutrition (PN) solutions when cholestasis develops. Little data
exist to support this practice. Fifty-four subjects with known serum Cu,
whole-blood Mn, and serum-conjugated bilirubin levels were evaluated in this
prospective, observational study. Subjects ranged in weight from 760 g to 65.2
kg. Subjects weighing <25 kg received a daily parenteral dose of 20μ
g/kg Cu and 5 μg/kg Mn. Subjects weighing ≥25 kg received a dose of
500 μg/d Cu and 150 μg/d Mn. Cholestasis was defined as a conjugated
bilirubin level ≥2 mg/dL. Of the 54 subjects, 20 had cholestasis. Fifteen
patients had elevated Cu levels, and 21 had high Mn levels. Seven of the
subjects had both high Cu and high Mn levels. The regression model comparing
cholestasis as a predictor of high, low, or normal Cu level was not
significant (P = .9588). Cholestasis was not a significant predictor
of high, low, or normal Mn levels (P = .6533). No correlation between
Cu and Mn levels was found. The authors found no significant relationship
between conjugated serum bilirubin levels ≥2.0 mg/dL, serum Cu, and
whole-blood Mn levels. They found insufficient evidence to support the
practice of dosing Mn from a Cu level or vice versa. They recommend obtaining
Cu and Mn levels on all pediatric patients who develop cholestasis prior to
adjusting parenteral doses and at regular intervals for all long-term PN
patients.</description><identifier>ISSN: 0884-5336</identifier><identifier>EISSN: 1941-2452</identifier><identifier>DOI: 10.1177/0884533608314529</identifier><identifier>PMID: 18390783</identifier><language>eng</language><publisher>United States: SAGE Publications</publisher><subject>Adolescent ; Bilirubin - blood ; Body Weight - physiology ; Child ; Child, Preschool ; cholestasis ; Cholestasis - blood ; copper ; Copper - administration & dosage ; Copper - blood ; Dose-Response Relationship, Drug ; Female ; Humans ; Infant ; Male ; manganese ; Manganese - administration & dosage ; Manganese - blood ; Nursing ; parenteral nutrition ; Parenteral Nutrition - adverse effects ; pediatric ; Prospective Studies ; Reference Values</subject><ispartof>Nutrition in clinical practice, 2008-04, Vol.23 (2), p.161-165</ispartof><rights>American Society for Parenteral and Enteral Nutrition</rights><rights>2008 by The American Society for Parenteral and Enteral Nutrition</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3811-4159f23255eb6fe51197f34bc05ed4cddfd5a13699c74e63a27287c5521d3f183</citedby><cites>FETCH-LOGICAL-c3811-4159f23255eb6fe51197f34bc05ed4cddfd5a13699c74e63a27287c5521d3f183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18390783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McMillan, Nancy B.</creatorcontrib><creatorcontrib>Mulroy, Cecilia</creatorcontrib><creatorcontrib>MacKay, Mark W.</creatorcontrib><creatorcontrib>McDonald, Catherine M.</creatorcontrib><creatorcontrib>Jackson, W. Daniel</creatorcontrib><title>Correlation of Cholestasis With Serum Copper and Whole-Blood Manganese Levels in Pediatric Patients</title><title>Nutrition in clinical practice</title><addtitle>Nutr Clin Pract</addtitle><description>Many institutions reduce or eliminate copper (Cu) and manganese (Mn) in
parenteral nutrition (PN) solutions when cholestasis develops. Little data
exist to support this practice. Fifty-four subjects with known serum Cu,
whole-blood Mn, and serum-conjugated bilirubin levels were evaluated in this
prospective, observational study. Subjects ranged in weight from 760 g to 65.2
kg. Subjects weighing <25 kg received a daily parenteral dose of 20μ
g/kg Cu and 5 μg/kg Mn. Subjects weighing ≥25 kg received a dose of
500 μg/d Cu and 150 μg/d Mn. Cholestasis was defined as a conjugated
bilirubin level ≥2 mg/dL. Of the 54 subjects, 20 had cholestasis. Fifteen
patients had elevated Cu levels, and 21 had high Mn levels. Seven of the
subjects had both high Cu and high Mn levels. The regression model comparing
cholestasis as a predictor of high, low, or normal Cu level was not
significant (P = .9588). Cholestasis was not a significant predictor
of high, low, or normal Mn levels (P = .6533). No correlation between
Cu and Mn levels was found. The authors found no significant relationship
between conjugated serum bilirubin levels ≥2.0 mg/dL, serum Cu, and
whole-blood Mn levels. They found insufficient evidence to support the
practice of dosing Mn from a Cu level or vice versa. They recommend obtaining
Cu and Mn levels on all pediatric patients who develop cholestasis prior to
adjusting parenteral doses and at regular intervals for all long-term PN
patients.</description><subject>Adolescent</subject><subject>Bilirubin - blood</subject><subject>Body Weight - physiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>cholestasis</subject><subject>Cholestasis - blood</subject><subject>copper</subject><subject>Copper - administration & dosage</subject><subject>Copper - blood</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>manganese</subject><subject>Manganese - administration & dosage</subject><subject>Manganese - blood</subject><subject>Nursing</subject><subject>parenteral nutrition</subject><subject>Parenteral Nutrition - adverse effects</subject><subject>pediatric</subject><subject>Prospective Studies</subject><subject>Reference Values</subject><issn>0884-5336</issn><issn>1941-2452</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqFkM1LxDAQxYMoun7cPUlO3qqZpmnaoxa_YNUFlT2WbDJdI91mTVrF_94suyAI4mkY5vce8x4hx8DOAKQ8Z0WRCc5zVnDIRFpukRGUGSRpXLbJaHVOVvc9sh_CG2NQcFnskr04SyYLPiK6ct5jq3rrOuoaWr26FkOvgg10avtX-oR-WNDKLZfoqeoMna6I5LJ1ztB71c1VhwHpGD-wDdR2dILGqt5bTSfRFbs-HJKdRrUBjzbzgLxcXz1Xt8n48eauuhgnmhcASQaibFKeCoGzvEEBUMqGZzPNBJpMG9MYoYDnZallhjlXqUwLqYVIwfAmRjogp2vfpXfvQ0xRL2zQ2LbxRTeEWrIs5i5lBNka1N6F4LGpl94ulP-qgdWrYuvfxUbJycZ7mC3Q_Ag2TUZArIFP2-LXv4b1QzVhkEPUJWtdUHOs39zgu9jR3498A-wDjtw</recordid><startdate>200804</startdate><enddate>200804</enddate><creator>McMillan, Nancy B.</creator><creator>Mulroy, Cecilia</creator><creator>MacKay, Mark W.</creator><creator>McDonald, Catherine M.</creator><creator>Jackson, W. Daniel</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200804</creationdate><title>Correlation of Cholestasis With Serum Copper and Whole-Blood Manganese Levels in Pediatric Patients</title><author>McMillan, Nancy B. ; Mulroy, Cecilia ; MacKay, Mark W. ; McDonald, Catherine M. ; Jackson, W. Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3811-4159f23255eb6fe51197f34bc05ed4cddfd5a13699c74e63a27287c5521d3f183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Bilirubin - blood</topic><topic>Body Weight - physiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>cholestasis</topic><topic>Cholestasis - blood</topic><topic>copper</topic><topic>Copper - administration & dosage</topic><topic>Copper - blood</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>manganese</topic><topic>Manganese - administration & dosage</topic><topic>Manganese - blood</topic><topic>Nursing</topic><topic>parenteral nutrition</topic><topic>Parenteral Nutrition - adverse effects</topic><topic>pediatric</topic><topic>Prospective Studies</topic><topic>Reference Values</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McMillan, Nancy B.</creatorcontrib><creatorcontrib>Mulroy, Cecilia</creatorcontrib><creatorcontrib>MacKay, Mark W.</creatorcontrib><creatorcontrib>McDonald, Catherine M.</creatorcontrib><creatorcontrib>Jackson, W. Daniel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nutrition in clinical practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McMillan, Nancy B.</au><au>Mulroy, Cecilia</au><au>MacKay, Mark W.</au><au>McDonald, Catherine M.</au><au>Jackson, W. Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Correlation of Cholestasis With Serum Copper and Whole-Blood Manganese Levels in Pediatric Patients</atitle><jtitle>Nutrition in clinical practice</jtitle><addtitle>Nutr Clin Pract</addtitle><date>2008-04</date><risdate>2008</risdate><volume>23</volume><issue>2</issue><spage>161</spage><epage>165</epage><pages>161-165</pages><issn>0884-5336</issn><eissn>1941-2452</eissn><abstract>Many institutions reduce or eliminate copper (Cu) and manganese (Mn) in
parenteral nutrition (PN) solutions when cholestasis develops. Little data
exist to support this practice. Fifty-four subjects with known serum Cu,
whole-blood Mn, and serum-conjugated bilirubin levels were evaluated in this
prospective, observational study. Subjects ranged in weight from 760 g to 65.2
kg. Subjects weighing <25 kg received a daily parenteral dose of 20μ
g/kg Cu and 5 μg/kg Mn. Subjects weighing ≥25 kg received a dose of
500 μg/d Cu and 150 μg/d Mn. Cholestasis was defined as a conjugated
bilirubin level ≥2 mg/dL. Of the 54 subjects, 20 had cholestasis. Fifteen
patients had elevated Cu levels, and 21 had high Mn levels. Seven of the
subjects had both high Cu and high Mn levels. The regression model comparing
cholestasis as a predictor of high, low, or normal Cu level was not
significant (P = .9588). Cholestasis was not a significant predictor
of high, low, or normal Mn levels (P = .6533). No correlation between
Cu and Mn levels was found. The authors found no significant relationship
between conjugated serum bilirubin levels ≥2.0 mg/dL, serum Cu, and
whole-blood Mn levels. They found insufficient evidence to support the
practice of dosing Mn from a Cu level or vice versa. They recommend obtaining
Cu and Mn levels on all pediatric patients who develop cholestasis prior to
adjusting parenteral doses and at regular intervals for all long-term PN
patients.</abstract><cop>United States</cop><pub>SAGE Publications</pub><pmid>18390783</pmid><doi>10.1177/0884533608314529</doi><tpages>5</tpages></addata></record> |
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| identifier | ISSN: 0884-5336 |
| ispartof | Nutrition in clinical practice, 2008-04, Vol.23 (2), p.161-165 |
| issn | 0884-5336 1941-2452 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70483997 |
| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Adolescent Bilirubin - blood Body Weight - physiology Child Child, Preschool cholestasis Cholestasis - blood copper Copper - administration & dosage Copper - blood Dose-Response Relationship, Drug Female Humans Infant Male manganese Manganese - administration & dosage Manganese - blood Nursing parenteral nutrition Parenteral Nutrition - adverse effects pediatric Prospective Studies Reference Values |
| title | Correlation of Cholestasis With Serum Copper and Whole-Blood Manganese Levels in Pediatric Patients |
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