Trace elements with selenium and iodide Disease Interactions

The trace metals, chromium and zinc, are excreted primarily in the urine. Selenium is partially excreted in the urine. Supplemental doses of these agents may need to be adjusted, reduced, or omitted in patients with renal dysfunction.

The trace elements, copper and manganese, are excreted in the bile. Copper and manganese doses may need to be adjusted, reduced, or omitted in patients with liver disease or biliary obstruction.

Elevated serum iodine levels can lead to altered thyroid function and metabolic abnormalities in patients receiving oral iodine therapy as well as topical therapy. Iodine should be used cautiously in patients with thyroid disorders. Monitoring thyroid function is recommended.

Manganese sulfate and manganese chloride preparations contain aluminum and may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which also contain aluminum. Patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration. Caution is advised in patients with renal impairment, particularly in premature or neonates patients.

Sodium iodide is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function.

The trace metals manganese, chromium, copper, selenium, and zinc are absorbed in the GI tract from dietary sources and following administration of oral supplements. GI absorption may be decreased in patients with malabsorption syndromes. Therefore, larger dosages may be required when these supplements are given orally. Parenteral administration may be appropriate.