Magnesium is an essential component in maintaining calcium
homeostasis. Magnesium infusions are often used for mothers with preterm
labor or preeclampsia and these infants may have symptoms of
hypermagnesemia. Magnesium levels should be monitored closely during the
initiation of parenteral nutrition and daily doses of 0.5 to 1 mEq/kg/day should be
administered.
Acetate is an anion that does not precipitate with calcium and therefore
helps to balance the metabolic acidosis that may occur with chloride
administration. Acetate is especially important in the preterm neonate who
normally excretes excess bicarbonate. Any time that acetate is used to treat
metabolic acidosis, the cause of the metabolic acidosis must be identified.
Trace elements are required for growth and metabolism in such small
amounts that individual supplementation is not feasible. The trace elements
solution is usually given as 0.15 mls/kg/day and consists of manganese 3.75
mcg, chromium 0.15 mcg, copper 15 mcg and selenium 2.25 mcg. Chromium
and selenium undergo renal excretion and therefore should be used cautiously in
patients with renal failure. Manganese and copper should be decreased in
patients with liver compromise due to impaired biliary excretion. Ceruloplasmin
levels should be checked two weeks after alterations of copper in parenteral
nutrition.