Chromium, parenteral nutrition supplement: Note: Chromium contamination is common with other parenteral nutrition products (eg, sodium phosphate, potassium phosphate and magnesium phosphate), which decrease or eliminate the need for routine supplementation (Olson 2019).
Routine supplement: IV: No addition of chromium (or a maximum of 1 mcg/day), due to potential accumulation (Vanek 2012).
Deficiency, prevention: Note: For patients with high intestinal fluid loss who are receiving long-term parenteral nutrition (Jeejeebhoy 1977).
IV: 20 mcg/day added to parenteral nutrition (Jeejeebhoy 1977).
Deficiency, treatment: IV: 150 to 200 mcg/day for up to 2 weeks added to parenteral nutrition, then resume maintenance dose of 20 mcg/day added to parenteral nutrition (Brown 1986; Freund 1979).
There are no dosage adjustments provided in the manufacturer's labeling; use with caution; omit dose in patients with severe kidney disease (Gallieni 1996).
There are no dosage adjustments provided in the manufacturer's labeling.
Chromium supplement for TPN: Infants, Children, and Adolescents: IV:
Infants 3 to 10 kg: 0.2 mcg/kg/day (Mirtallo 2004).
Children 10 to 40 kg: 0.14 to 0.2 mcg/kg/day (Mirtallo 2004).
Adolescents >40 kg: 5 to 15 mcg/day (Mirtallo 2004).
Manufacturer’s labeling: Dosing in the prescribing information may not reflect current clinical practice. 0.14 to 0.2 mcg/kg/day.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution; consider reducing or omitting dose in patients with severe kidney disease. ASPEN Guidelines recommend decreasing dose in pediatric patients. (Mirtallo 2004)
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing; use with caution.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 40 mcg/10 mL (10 mL)
Yes
Strength of chromic chloride injection is expressed as elemental chromium
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Micro-Cr: 40 mcg/10 mL (10 mL)
IV: For IV use only. Must be diluted prior to use in a volume of fluid not less than 100 mL. Do not administer undiluted by direct injection into a peripheral vein. Solution is acidic; direct intramuscular (IM) or intravenous (IV) injection is contraindicated.
IV: For IV use only. Typically administered as part of parenteral nutrition solution infusion. Do not administer undiluted by direct injection into a peripheral vein. Solution is acidic; direct IM or IV injection is contraindicated.
Chromium, parenteral nutrition supplement: Chromium supplement for parenteral nutrition to maintain chromium serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.
There are no adverse reactions listed in the manufacturer's labeling.
Direct IM or IV injection.
Concerns related to adverse effects:
• Aluminum toxicity: Contains aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or in patients with renal impairment. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of greater than 4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; omit dose in patients with severe kidney disease (Gallieni 1996).
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted.
It is not known if chromic chloride is present in breast milk. The manufacturer recommends that caution be exercised when administering chromic chloride to nursing women.
Helps to maintain normal glucose metabolism and peripheral nerve function and prevents development of impaired glucose tolerance, ataxia, peripheral neuropathy, and a confusional state similar to mild/moderate hepatic encephalopathy.
Excretion: Urine and bile.
Solution (Chromic Chloride Intravenous)
40MCG/10ML (per mL): $2.38 - $3.12
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