Trace Minerals

  • Diagnosis
  • Screening
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Deficiency – patient with chronic illness, malabsorption, or postbariatric surgery
  • Toxicity – patients with known exposure (eg, industrial accident)

Laboratory Testing

  • Order testing based on clinical scenario and/or presence of symptoms
    • Nutritional deficiency – fasting serum or plasma testing
      • Red blood cell (RBC) testing has limited usefulness in assessing dietary intake
    • Toxicity – urine testing
      • Not recommended for assessing current nutritional status
  • Not recommended in general population
  • May be indicated in at-risk populations or for those on chronic parenteral feeding

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 the following

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

Individual Trace Minerals

Trace Minerals

 

Chromium

Copper

Selenium

Zinc

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)

Integral part of numerous enzyme systems including amine oxidase, ferroxidase, superoxide dismutase, dopamine hydroxylase

Component of the enzyme glutathione peroxidase

Serves to protect proteins, cell membranes, lipids, and nucleic acids from oxidant molecules

Integral component of metalloenzymes

Synthesizes and stabilizes proteins, DNA, and RNA

Sources

Yeast, meat, grain products

Shellfish, liver, nuts, legumes, bran, organ meats

Seafood, muscle meats, cereals

Meat, shellfish, nuts, legumes

Deficiency

Impaired glucose tolerance (poor evidence, largely historical, very flawed studies)

Anemiaosteopenia, degenerative changes in aortic elastin, growth retardation, hair pigment changes, cerebral and cerebellar degeneration (prototype is Menkes syndrome)

Cardiomyopathy and heart failure (Keshan disease), striated muscle degeneration, deforming arthritis (Kashin-Bek disease)

Present in as many as 20% of patients postbariatric surgery

Growth retardation, alopecia, dermatitis, diarrhea, failure to thrive, congenital malformations

Toxicity

Dermatitis, renal failure, metal fume fever, pulmonary cancers (from chromium VI)

Only in industrial exposures

Nausea, emesis, diarrhea, hemolytic anemia, neurodegeneration, hepatic failure, Wilson disease 

Toxicity more likely at intake of 10 mg/day

Alopecia, nausea, emesis, dermatitis, peripheral neuropathy

Reduced copper absorption, gastritis, fever, nausea, emesis, metal fume fever

300-600 mg/day may induce sideroblastic anemia

Recommended daily adult intake

25-35 mcg/day considered adequate

900 mcg/day

55 mcg/day

8-11 mg/day

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.

Chromium, Serum 0098830
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Copper, Serum or Plasma 0020096
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Limitations 

Serum copper may be elevated with inflammation, infection, pregnancy, birth control pills

Serum copper may be lowered by corticosteroids, zinc, malnutrition, malabsorption

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

Selenium, Serum or Plasma 0025023
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Selenium, RBCs 2013011
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

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

Zinc, Serum or Plasma 0020097
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Limitations 

Zinc may be lowered with malnutrition, inflammation, infection, pregnancy, birth control pills, and steroids

Zinc may be elevated with zinc supplementation or fasting

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

General References

Institute of Medicine of the National Academies. Summary Tables, Dietary Reference Intakes. Otten JJ, Hellwig JP, Meyers LD. Dietary Reference Intakes The Essential Guide to Nutrient Requirements, Washington, DC: National Academies Press, 2006.

Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin North Am. 2009; 56(5): 1085-103. PubMed

Kumar N. Neurologic presentations of nutritional deficiencies. Neurol Clin. 2010; 28(1): 107-70. PubMed

Marian M, Sacks G. Micronutrients and older adults Nutr Clin Pract. 2009; 24(2): 179-95. PubMed

Schweitzer DH, Posthuma EF. Prevention of vitamin and mineral deficiencies after bariatric surgery: evidence and algorithms. Obes Surg. 2008; 18(11): 1485-8. PubMed

Shah MD, Shah SR. Nutrient deficiencies in the premature infant. Pediatr Clin North Am. 2009; 56(5): 1069-83. PubMed

Suskind DL. Nutritional deficiencies during normal growth. Pediatr Clin North Am. 2009; 56(5): 1035-53. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology®

Bornhorst JA, Hunt JW, Urry FM, McMillin GA. Comparison of sample preservation methods for clinical trace element analysis by inductively coupled plasma mass spectrometry. Am J Clin Pathol. 2005; 123(4): 578-83. PubMed

Haglock-Adler CJ, Strathmann FG. Simplified sample preparation in the simultaneous measurement of whole blood antimony, bismuth, manganese, and zinc by inductively coupled plasma mass spectrometry Clin Biochem. 2015; 48(3): 135-9. PubMed

Lin C, Wilson A, Church BB, Ehman S, Roberts WL, McMillin GA. Pediatric reference intervals for serum copper and zinc. Clin Chim Acta. 2012; 413(5-6): 612-5. PubMed

Medical Reviewers

Grenache, David G., PhD, Medical Director, Special Chemistry; Co-Director, Electrophoresis and Manual Endocrinology; Chief Medical Director, Clinical Chemistry at ARUP Laboratories; Associate Professor of Clinical Pathology, University of Utah

Content Reviewed: 
June 2017

Last Update: August 2017