Diarrhea malabsorption and

Trace elements are essential cofactors for numerous biochemical processes. Trace elements that are added routinely to PN include zinc, selenium, copper, manganese, and chromium. There are various commercial parenteral trace element formulations that can be added to PN admixtures (e.g., MTE-5 ). Zinc is important for wound healing, and patients with high-output fistulas, diarrhea, burns, and large open wounds may require additional zinc supplementation. Patients may lose as much as 12 to 17 mg zinc per liter of gastrointestinal (GI) output (e.g., from diarrhea or enterocutaneous fistula losses) however, others have demonstrated that 12 mg/day may be adequate to maintain these patients in positive zinc balance.18 Patients with chronic diarrhea, malabsorption, and short-gut syndrome may have increased selenium losses and may require additional selenium supplementation. Patients with severe cholestasis should have copper and manganese... 

Lactoferrin, a protein found in secondary granules of polymorphonuclear cells, was observed to be mildly to moderately elevated in the stools of children with endemic cryptosporidiosis [91] and healthy adult volunteers with experimental infection [92], Indeed, in another study of malnourished children in Haiti, cryptosporidiosis was noted to stimulate an inflammatory response, as evidenced by elevated IL-8, TNF-a, lactoferrin, IL-13 and IL-10 [93]. Further studies are needed to elucidate the role of inflammatory mediators in the development of prolonged diarrhea, malabsorption and malnutrition in immunocompromised hosts and children in endemic areas. 

Chronic use or overdosage may result in electrolyte disturbances, such as hypokalemia, hypocalcemia, and metabolic acidosis or alkalosis, persistent diarrhea, malabsorption, and weight loss. Electrolyte disturbance may produce vomiting and muscle weakness. 

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