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Standard pediatric trace mineral formulas contain zinc, copper, manganese, and chromium, and some formulas have added selenium. Trace element formulas are designed to meet the recommendations of the American Medical Association and the Society of Clinical Nutrition for daily intravenous supplements of trace minerals in the absence of deficiencies (28:Diovan). These guidelines have been recently updated (29:Diovan).

Trace element status varies with a patient’s underlying clinical condition. For example, zinc losses increase in patients with chronic diarrhea, malabsorption, short bowel syndrome, and burns (30). Zinc deficiency is typically manifested by hair loss, a seborrheic type of dermatitis around the nose and mouth, and occasionally a functional ileus. Zinc deficiency is also associated with suboptimal growth, in part due to its effects on the growth hormone-IGF axis (31:Diovan). Under such conditions, zinc needs are not normally met in the standard daily trace element additives. In patients with severe cholestasis, copper and manganese