TRACE

ELEMENT
S
• Naturally occurring, homogeneous, inorganic substance required in
humans in amounts less than 100 mg/day
• Minerals for 5% of our diet
• Essential trace elements are Iron, zinc, copper Co, Cr, fluoride, iodide, Mn,
Mo, & Se
Iron
• Most essential trace element
• Body content – 4-6g Hb – 68% ferritin – 13 % haemosiderin – 12%
myoglobin – 3% iron enzymes – 0.2% 6
• Iron dependent enzymes: Cytochrome oxidase, xanthine oxidase and
peroxidase
• Body requirement Daily requirement – 0.5 - 2 mg/day 3 - 5mg/day
(pregnancy) Daily excretion – 0.9mg/day 1.3mg/day (during menses) 7 •
• Dietary source: Leafy greens, whole grains, beans , pulses, liver, spleen,
mollusks
• Iron is absorbed in ferrous form, which is measurable in blood as free iron
Transferrin
• Transport protein
• Binds to two iron molecules
• Transports iron to various organs and tissues
• S.Iron + total iron bound transferrin – total iron in circulation
• Determination of transferrin gives TIBC
• Transferrin can be measured by RIA, ELISA & chemiluminescence
Ferritin
• Protein having 24 subunits binds to 4000 iron molecules
• Measurements used to assess iron stores in the body
• ↑ferritin levels may be seen in hepatitis, cirrhosis, hepatic carcinoma also in
leukemia, NHL
• RIA, ELISA chemiluminescence
• Deficiency state: asymptomatic weakness, headache, irritability, and varying
degrees of fatigue and exercise intolerance.
• Treatment: 3-6mg of elemental iron/kg/day
Oral preparations of iron: Ferrous sulphate, Ferrous fumerate, Ferrous
gluconate Ferrous succinate, Iron calcium complex, Ferric ammonium
citrate

Adverse effects: epigastric pain, nausea, vomiting, gastritis, metallic taste,

constipation or diarrhea Liquid prep- staining of teeth 13 •

Parenteral preparations: Iron dextran, Iron sorbitol citric acid complex

Adverse effects: Pain at injection site, pigmentation Fever, headache,

palpitations, anaphylaxis
Acute iron poisoning: 60mg/kg elemental iron

Toxicity Symotoms:
Vomiting, abdominal pain, bloody diarrhea, shock, dehydration, cyanosis,
acidosis, coma

Treatment: Gastric lavage with sodium bicarbonate solution, Desferrioxamine

15 mg/kg per hour IV, ↑ to max 35 mg/kg per hour, Correction of acidosis
and shock (if fails dialysis)
Zinc
• Second most abundant trace element
• Cofactor – DNA polymerase, alkaline phosphatase, carboxypeptidase
Regulate- growth, immune system, collagen synthesis, wound healing,
bone metabolism, reproduction, taste, smell & vision
• Reduce the time period of diarrhea
• High dose of zinc prevents dysmenorrhea
• Zinc required in producing testosterone
• For common cold
• In treatment of warts
• Body content 2.5g 60% in muscle, 30% in bone, 10% in body tissues and
organs

• Daily requirement: 3-14mg

• Diet rich in zinc: red meat, fish, sea food, pumpkin, cashews, beans, dark
chocolate

• Zinc deficiency: Leukemia, cirrhosis, hepatitis, sickle cell anemia,

Malnutrition Symptoms: In children- growth retardation & skeletal
abnormalities In adults- ↓smell & taste, ↓appetite, skin lesions, and hair loss
• Zinc deficiency is also associated with:
• Acrodermatitis enteropathica, Anorexia, Esophageal squamous cell
carcinoma , Cognitive and motor impairement, Diarrhea and
pneumonia

• Treatment: Zinc supplements 45 – 100mg/day

Copper
• 3rd most important trace element
• Diet rich in copper: red meat, shell fish, water pumped through copper
pipes
• Body content of copper is 80-120mg
• 40-60% absorbed in duodenum
• Transported through metallozymes eg ascorbic acid
• 90% bound to ceruplasmin, 9% to albumin and 1% is free
• Body content of Cu is 80-120mg
• Body functions: Erythropoiesis, Nerve conduction and immune function,
Fertility and to maintain pregnancy •
• Act as a catalyst for copper containing enzymes Eg: tyrosinase, ascorbic
acid
• Toxic – 5mg/kg
• Adequate – 34mcg/kg
• Deficient - <8.5mcg/kg
• RDA – 09 - 1.3mg/day

Deficiency symptoms:
• Fragile hair, Depigmented skin, Myeloneuropathy, Edema,
Hepatosplenomegaly, Osteoporosis , Anemia, neutropenia

Treatment:
• life long treatment, Avoidance of high Cu diet, In early stages Zn may be
effective as it competes with Cu for absorption, Penicillamine
Chromium
• Regulates plasma lipoprotein concentration and reduces cholesterol and
triglycerides.
• Found in – grains, cereals, fruits, processed meat 29
• RDA : 20 – 35 mcg/ day
• In improving lean body mass

Deficiency:
• Limited to hospitalized patients on TPN

Toxicity :
• Lung Ca, Bronchogenic Ca in stainless steel workers • Dermatitis, skin
ulcers
Fluoride
• Very important in preventing dental caries
• Promotes remineralization of decalcified enamel
• Available as tooth paste, solutions and gels Excess cause flurosis
• Rx- tooth bleeching, microabrasion, replacement
Iodine
Thyroid hormone synthesis and also have broad spectrum germicidal action •

Iodine induced hyperthyroidism:

• In individuals of nodular goiter in endemic area, thyrotoxicosis due to
underlying areas of autonomy (Jod Basedow phenomenon)
Iodine induced hypothyroidism:
• People at risk are with autoimmune thyroiditis, Graves hyperthyroidism
previously treated with radioactive iodine
• Unusually sensitive to inhibitory effect due to sustained activity on Na/I
symporter ( Wolff Chaikoff effect ).

Iodine deficiency prophylaxis:

• Iodised salt, Iodised oil, Iodised water, Iodine tablets or drops,
Biofortification of vegetables with iodine,
• Also available as ointment, solution, mouth gargles
Manganese
• Shown to be essential for normal growth and development

Dietary sources:
• meat, fish, poultry, dry fruits and nuts •

• Biological role: manganese superoxide dismutase arginase, glutamate

synthase & pyruvate carboxylase •

Deficiency :
• ↓growth, ↓fertility, ataxia, skeletal deformities, abnormal fat and CHO
metabolism 36 •

Toxicity:
• Neurotoxic- extrapyramidal parts affected Headache Hepatic dysfunction •
RDA – 2-11mg/day
Molybdenum
• Act as a catalyst for enzymes and helps facilitate breakdown of certain
amino acids
• Molybdenum in human tooth enamel may have a role in lowering the risk
of tooth decay.
• Deficiency – esophageal carcinoma
• RDA: 45mcg/day pregnancy and lactation 50mcg/day
Selenium
• Least abundant trace element
• Recommended intake for adults 50-200 μg/day
• Selenium in Glutathione peroxidase (GTH-Px)- important role immune
system function, also plays a crucial role in the control of oxygen
metabolism, protects body from oxidative damage.
• Low GTH-Px in platelets leads to bleeding disorders & edema due to
damage to capillary membranes
• Protects phagocytes from destruction
• GTH-Px protects eye lens tissues and neurons from damage

Low Selenium leads to Keshan’s disease, which is a type of cardiac myopathy

discovered in china where soil Selenium was absent.

Selenium deficiency occurs due to: Hemolytic anemia, Clansman's

thrombasthenia (platelet disorder), Gastrointestinal cancer, Malnutrition
Vanadium
• Control of sodium pump, inhibition of ATPase

Tin
• Structural role in connective tissue, in metabolism of osteogenic cells

Nickel
• Component of enzyme urease
Boron
• Boron is a vital trace mineral that is required for the normal growth and
health of the body.
• apples, oranges, red grapes, kiwis, dates, as well as certain vegetables,
avocado, soybeans and nuts are rich sources of boron
• Prevents arthritis
• Used for body building
• Estrogen Production: Boron can improve the production of estrogen in
menopausal women
• Embryonic development: Boron appears to be essential for reproduction
and the development of the fetus
• Proper cell membrane functions
• Lowers plasma lipid levels
Lithium
• Discovered in 1817 as mood stabilizing agent

MOA:
• Inositol depletion theory, Inhibition of NMDA receptor mediated signalling,
Inhibition of GSK3, BDNF upregulation

Adverse effects:
• Nephrogenic diabetes insipidus, Thyroid function abnormalities, mental
confusion, hyperreflexia, gross tremor, dysarthria, Seizures, cardiac
arrhythmias, hypotension, and • albuminuria.

Uses:
• BPD, Mania, Depression, Cancer induced leukopenia & agranulocytosis

Preparation: •
• Lithium carbonate 150/300/600mg, Lithium citrate syrup 8mEq/5ml
Xenon
• A trace element in earths atmosphere
• Xenon is a medical gas capable of establishing neuroprotection, inducing
anesthesia and nuclear medicine as a contrast agent
• Acts through NMDA receptor
REFERENCE FOR VITAMINS AND TRACE
ELEMENTS
Henry’s Clinical Diagnosis and Management by Laboratory Methods