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Journal of Parenteral and Enteral Nutrition
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Case Reports

Neurologic Symptoms Due to Possible Chromium Deficiency in Long-Term Parenteral Nutrition That Closely Mimic Metronidazole-Induced Syndromes

Albert H. Verhage, MD

Department of Medicine, St Michael's Hospital and the University of Toronto, Ontario, Canada, University Hospital Rotterdam, Department of Internal Medicine II, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands

Wei K. Cheong, MB, BS

Department of Medicine, St Michael's Hospital and the University of Toronto, Ontario, Canada, Singapore General Hospital, Department of Medicine II, Outram Road Singapore 0316, Singapore

Khursheed N. Jeejeebhoy, MB, BS, PHD

Department of Medicine, St Michael's Hospital and the University of Toronto, Ontario, Canada

Background: We previously described a patient on home parenteral nutrition (HPN) who developed glucose intolerance and neuropathy that only responded to an infusion of chromium. A patient on HPN who had neuropathy and glucose intolerance was studied. He was also on metronidazole, which could have caused the neuropathy, but the symptoms and signs persisted. Methods: Baseline clinical examination, nerve conduction studies, serum vitamin and trace element levels, and glucose tolerance were measured. Then, 250 µg of trivalent chromium as the chloride salt was infused daily for 2 weeks. The above studies were repeated. Results: The patient at baseline had peripheral neuropathy of the axonal type and was glucose intolerant. Serum chromium was raised in this patient above the reference range. Despite raised serum levels, the infusion of chromium resulted in clinical remission that was marked 4 days after starting the infusion. Normalization of nerve conduction also occurred within 3 weeks of the initial study. Conclusions: Neuropathy and glucose intolerance may occur despite increased serum chromium levels and respond to chromium infusion. The previous use of drugs such as metronidazole should not exclude chromium as a potential treatment for neuropathy in HPN patients. (journal of Parenteral and Enteral Nutrition 20:123-127, 1996)

Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 2, 123-127 (1996)
DOI: 10.1177/0148607196020002123
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 J. Am. Coll. Nutr.Home page
R. A. Anderson
Chromium, Glucose Intolerance and Diabetes
J. Am. Coll. Nutr., December 1, 1998; 17(6): 548 - 555.
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