Trace Minerals

Diagnosis

Indications for Testing

  • Patient with chronic illness, malabsorption, or postbariatric surgery
  • Patients with known exposure (eg, industrial accident)

Laboratory Testing

  • Order testing based on clinical scenario and/or presence of symptoms
    • Chromium, copper, selenium, zinc
    • Fasting serum or plasma testing – best reflects current nutritional status
    • Urine testing – may be useful for detecting exposures and for monitoring decontamination efforts
      • Not recommended for assessing current nutritional status

Screening

  • Not recommended in the general population
  • May be indicated in at-risk populations or for those on chronic parenteral feeding

Clinical Background

The primary trace minerals of nutritional significance are chromium, copper, selenium, and zinc. Signs and symptoms of toxicity correlate with routes of exposure, specific elemental forms to which a person is exposed, and whether exposure is acute or chronic. Deficiencies of these minerals may exist in

  •  Patients with
    • Chronic illness (eg, HIV)
    • Malabsorption syndrome
    • Unbalanced diet or parenteral nutrition
    • Pica
  • Postbariatric surgery patients
  • Preterm infants

Individual Trace Minerals

  • Chromium
    • Function – potentiates the action of insulin in patients with impaired glucose tolerance
      • May also improve lipid profiles – proven in animal studies but not in humans
    • Sources – yeast, meat, grain products
      • 30 µg/day considered adequate
    • Deficiency – impaired glucose tolerance
      • Poor evidence, largely historical, very flawed studies
    • Toxicity – dermatitis, renal failure, metal fume fever, pulmonary cancers (from chromium VI)
      • Unknown outside of industrial exposures
    • Recommended daily intake (RDI) – no need for chromium supplementation (FDA and American Diabetes Association)
    Copper
    • Function – integral part of numerous enzyme systems including amine oxidase, ferroxidase, superoxide dismutase, dopamine hydroxylase
    • Sources – shellfish, liver, nuts, legumes, bran, organ meats
    • Deficiency –   anemia, osteopenia, degenerative changes in aortic elastin, growth retardation, hair pigment changes, cerebral and cerebellar degeneration (prototype is Menkes syndrome)
    • Toxicity – nausea, emesis, diarrhea, hemolytic anemia, neurodegeneration, hepatic failure, Wilson disease
      • Toxicity more likely at intake of 10 mg/day 
    • RDI – 0.9 mg/day
    Selenium
    • Function – component of the enzyme glutathione peroxidase
      • Serves to protect proteins, cell membranes, lipids, and nucleic acids from oxidant molecules
    • Sources – seafood, muscle meats, cereals
    • Deficiency – cardiomyopathy and heart failure (Keshan disease), striated muscle degeneration, deforming arthritis (Kashin-Bek disease)
      • Present in as many as 20% of patients postbariatric surgery
    • Toxicity – alopecia, nausea, emesis, dermatitis
    • Supplementation – recommended postbariatric surgery
    • RDI – 35 µg/day
    Zinc
    • Function – integral component of metalloenzymes
      • Synthesizes and stabilizes proteins, DNA, and RNA
    • Sources – meat, shellfish, nuts, legumes
    • Deficiency – growth retardation, alopecia, dermatitis, diarrhea, failure to thrive, congenital malformations
    • Toxicity – reduced copper absorption, gastritis, fever, nausea, emesis, metal fume fever
      • 300-600 mg/day may induce sideroblastic anemia
    • Supplementation – recommended with clinical management of childhood diarrhea
    • RDI – 15 mg/day

Indications for Laboratory Testing

  • Tests generally appear in the order most useful for common clinical situations
  • Click on number for test-specific information in the ARUP Laboratory Test Directory
Test Name and Number Recommended Use Limitations Follow Up
Chromium, Serum 0098830
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Monitor chromium concentrations; detect possible deficiency or overload

Fasting morning specimens are best to avoid postprandial fluctuation  
Copper, Serum or Plasma 0020096
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Monitor copper levels; detect possible deficiency or overload

Elevated with inflammation, infection, pregnancy, birth control pills

Copper may be lowered by corticosteroids, zinc, malnutrition, malabsorption

 
Copper, Serum Free (Direct) 0020596
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Monitor the free (non-ceruloplasmin bound) fraction of copper; ideal for detection of copper overload

Fasting morning specimens are best to avoid postprandial fluctuation  
Selenium, Serum or Plasma  0025023
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Monitor selenium concentrations; detect possible deficiency or overload

Fasting morning specimens are best to avoid postprandial fluctuation  
 Zinc, Serum or Plasma 0020097
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Monitor zinc concentrations; detect possible deficiency or overload

Depressed with inflammation, infection, pregnancy, birth control pills, and steroids

False elevations with hemolysis

Fasting morning specimens are best to avoid postprandial fluctuation

 
Zinc, RBC 2006460
Method: Quantitative Inductively Coupled Plasma-Optical Emission Spectrometry

Monitor zinc concentrations; detect possible deficiency or overload

   
Additional Tests Available
 
Click the plus sign to expand the table of additional tests.
Test Name and NumberComments
Chromium, Urine 0025068
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Not recommended for nutritional assessment

Copper, Urine 0020461
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Not recommended for nutritional assessment

Selenium, Urine 0025067
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Not recommended for nutritional assessment

Zinc, Urine 0020462
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Not recommended for nutritional assessment