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Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition.

Abstract

A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. Chromium balance was negative. Chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism.

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    MeSH

    Adult
    Ataxia
    Body Weight
    Chromium
    Energy Intake
    Fatty Acids, Nonesterified
    Female
    Glucose
    Glucose Tolerance Test
    Humans
    Insulin
    Neural Conduction
    Nitrogen
    Parenteral Nutrition
    Parenteral Nutrition, Total
    Paresthesia
    Peripheral Nervous System Diseases
    Time Factors

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    192066

    Citation

    Jeejeebhoy, K N., et al. "Chromium Deficiency, Glucose Intolerance, and Neuropathy Reversed By Chromium Supplementation, in a Patient Receiving Long-term Total Parenteral Nutrition." The American Journal of Clinical Nutrition, vol. 30, no. 4, 1977, pp. 531-8.
    Jeejeebhoy KN, Chu RC, Marliss EB, et al. Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am J Clin Nutr. 1977;30(4):531-8.
    Jeejeebhoy, K. N., Chu, R. C., Marliss, E. B., Greenberg, G. R., & Bruce-Robertson, A. (1977). Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. The American Journal of Clinical Nutrition, 30(4), pp. 531-8.
    Jeejeebhoy KN, et al. Chromium Deficiency, Glucose Intolerance, and Neuropathy Reversed By Chromium Supplementation, in a Patient Receiving Long-term Total Parenteral Nutrition. Am J Clin Nutr. 1977;30(4):531-8. PubMed PMID: 192066.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. AU - Jeejeebhoy,K N, AU - Chu,R C, AU - Marliss,E B, AU - Greenberg,G R, AU - Bruce-Robertson,A, PY - 1977/4/1/pubmed PY - 1977/4/1/medline PY - 1977/4/1/entrez SP - 531 EP - 8 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 30 IS - 4 N2 - A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. Chromium balance was negative. Chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism. SN - 0002-9165 UR - https://www.unboundmedicine.com/medline/citation/192066/full_citation L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/30.4.531 DB - PRIME DP - Unbound Medicine ER -