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SummaryTrace elements are inorganic ions that occur in human and animal tissues in minute quantities.Although trace elements are found in the body in very small amounts, their effect on well-being is dramatic. Deficiencies clearly are reported more often than toxicities. These deficiencies may arise from inadequate dietary intake, decreased bioavailability, iatrogenic factors, decreased transport protein, excessive excretion, and certain disease states in which there is decreased absorption, as well as normal physiologic states in which trace element requirements are increased.The aim of this work is to find out the incidence of some trace mineral deficiency and the time of occurrence of this deficiency in relation to the long stay period of patients in ICU. Also we tryed to find a correlation between the deficiency and the clinical condition and outcome of the patients.Our study was performed on 55 adult critically ill patients selected upon their admission to postoperative and emergency ICU Zagazig University hospitals. Patients were chosen from those referred to the ICU with polytrauma, sepsis, and respiratory failure.At the end of the study patients were classified into one of the three groups according to their evident final diagnosis: (group I) severe multiple injuries, (group II) SIRS &septic patients, and (group III) respiratory failure. Each one of the three groups was further subdivided into 2 subgroups according to nutrients intake: subgroup (A), enterally-fed; and subgroup (B), parenterally-fed.Within each subgroup, serum level of each trace element on day 3, day 7, day 15 and day 21 was compared to its serum level of day 0 (baseline value). Also, comparison between the two subgroups of each group at similar times was done.Also, mortality rate, length of ICU stay, and duration of mechanical ventilation were recorded and compared between the two subgroups.The mean plasma Zinc , Copper ,selenium, Manganese and Molybdenum concentration measured at the time of admission in the whole population (n = 55) and it was significantly less than the reference population values for serum Zn, Cu, and SeAt the time of admission, a significantly negative correlation was found between plasma selenium concentrations and APACHE II scoresWe found also statistically negative correlation between low serum selenium concentration on admission and OSF, and VAP.Blood determinationGroup ? (Polytrauma patients):Plasma trace element concentrations were low upon admission in the two subgroups the serum selenium concentrations increased slowly, reverting to the normal reference range by D15Cu and Zn concentrations did not differ between subgroups: they were low upon admission, and normalized over time.CRP levels were increased in all groups, the D3 concentration being higher than D7. Albumin concentrations were low upon admission, and reached the lowest values on D0 and D3, to normalize thereafter (ns between subgroups)Group ?? (Sepsis patients):Serum trace element concentrations were low upon admission and remain low even decrease more in non-survivors.Group ??? (Respiratory Failure):Serum trace elements were affected by the disease process, condition of the patients on admission i.e.presence or absence of acute phase response or sepsis(from SIRS till septic shock).For example patients admitted with MG(myasthenia gravis) or drug overdose did not suffer large dynamic changes in trace elements status unless exposed to infectious or septic complications which were even less likely to occur. Another point, most of these patients have functioning GIT so, enteral nutrition was prescribed to them.As regard morbidity and mortality, ther were statistically negative correlation between trace elements status and APACHE ?? score, VAP(ventilator associated pneumonia),and OSF(organ system failure).Serum manganese and molybdenum showed little dynamic changes in the three groups.Finally, we reached the conclusion that trace elements should be supplied on individual basis, i.e. supplying only the elements that are clearly indicated on nutritional or therapeutic basis to patients according to their age, sex, disease status, requirements, losses, and unrecognized intake as contaminants of other nutritional products or infusions. Dose, timing and route should also be individualized. Also, laboratory assessment of trace element status should be performed as baseline before starting the nutritional program and on specified intervals using one of the available tests that should be specific, sensitive, cost-beneficent and easy to perform.
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