In PN with elevated bilirubin, which statement about trace element management is accurate?

• A. Removal of all trace elements is warranted
• B. Removal of all trace elements is not warranted
• C. Trace elements do not affect bilirubin
• D. Only manganese should be removed

Answer: (B)

In PN with elevated bilirubin, the body’s ability to excrete trace elements is impaired, but trace elements are still essential for many bodily functions. You don’t remove all trace elements because that would risk deficiencies and impair healing and immunity. Instead, you adjust selectively: copper and manganese are mainly excreted via bile and tend to accumulate in cholestasis, so reducing or withholding these two helps limit hepatic toxicity. Zinc and selenium are typically continued to maintain normal nutritional status. This approach balances preventing element overload with maintaining necessary micronutrients.