Multrys is a sterile intravenous (IV) trace-element concentrate used as a source of four essential trace elements—zinc, copper, manganese, and selenium—for patients who are receiving parenteral nutrition (PN/TPN) and therefore may not be able to obtain or absorb enough of these micronutrients through the gastrointestinal tract.
It is supplied as 1 mL single‑dose vials, commonly packaged as 25 vials per box (“1 mL x 25/Box”). Multrys is intended to be added to a PN admixture (or otherwise diluted in an appropriate IV solution) and is not meant to be administered undiluted.
What it contains (active components) and what they do
Multrys provides four trace elements that function as enzyme cofactors and are required for normal metabolism, antioxidant defense, immune function, hematologic function, and tissue repair. In PN patients, trace elements are typically provided daily in small, carefully monitored amounts.
1) Zinc
Physiologic roles
- Cofactor for hundreds of enzymes (protein/DNA synthesis, cell division)
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Immune function and wound healing
- Taste/smell, skin integrity
- Supports growth and development (important in pediatric PN)
Deficiency risk is higher with
- High GI losses (diarrhea, ostomy/fistula output)
- Burns, trauma, sepsis/catabolic states
- Long-term PN without adequate supplementation
Excess/toxicity concerns
- Can contribute to copper deficiency over time at high doses (competitive absorption in enteral settings; clinically, labs are still monitored in PN)
2) Copper
Physiologic roles
- Iron metabolism (ceruloplasmin), red blood cell formation
- Connective tissue and nervous system function
- Immune function, antioxidant enzymes
Deficiency risk is higher with
- Long-term PN without copper
- Malabsorption states
Accumulation risk
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Cholestasis/biliary obstruction (copper is primarily eliminated via bile). In PN-associated cholestasis, copper may need dose reduction/withholding based on labs and clinical status.
3) Manganese
Physiologic roles
- Cofactor in carbohydrate/amino acid metabolism
- Bone/cartilage formation
- Antioxidant enzyme activity (e.g., manganese superoxide dismutase)
Accumulation/toxicity concerns (especially important)
- Eliminated mainly via bile; can accumulate in cholestasis/hepatic dysfunction
- Excess manganese exposure has been associated with neurologic toxicity (Parkinsonian-like symptoms) and MRI basal ganglia signal changes in long-term PN when levels are high
4) Selenium
Physiologic roles
- Integral to glutathione peroxidase and other selenoproteins
- Antioxidant defense, thyroid hormone metabolism, immune function
Deficiency risk is higher with
- Long-term PN without selenium
- Critical illness/catabolic states
Excess/toxicity concerns
- With excessive dosing or reduced clearance, can cause symptoms of selenosis (GI upset, hair/nail changes, neuropathy—classically with chronic excess).
What it is used for (clinical indication)
Multrys is used to help meet daily trace element requirements in patients receiving parenteral nutrition when oral/enteral intake is inadequate or not possible.
Key point: Multrys is not a complete nutrition product. PN patients also require:
- Macronutrients (dextrose, amino acids, lipids)
- Electrolytes/minerals
- Vitamins
- Fluids and caloric goals tailored to the patient
How it’s given (route, dilution, and administration principles)
Route
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Intravenous, typically as part of a compounded PN solution (TPN bag) administered via central venous access when osmolarity requires it.
Must be diluted / added to PN
- Trace element concentrates like Multrys are generally not intended for direct IV push.
- Administration is typically once daily as part of the daily PN bag, but the exact regimen is individualized.
Compatibility/compounding considerations (high-level)
- Trace elements can participate in stability/compatibility issues in PN (e.g., interactions influenced by pH, phosphate, calcium, and overall formulation).
- PN compounding should follow institutional standards and applicable sterile compounding regulations (e.g., USP <797> in the U.S.).
Dosing
Exact dosing is not one-size-fits-all and depends on:
- Age/weight (adult vs pediatric)
- Degree of stress/catabolism (burns, sepsis)
- GI losses (diarrhea, fistula output)
- Hepatic function (especially cholestasis)
- Renal function (for selenium considerations)
- Baseline levels and trends on monitoring
In practice, clinicians start with labeled daily PN trace-element dosing and then adjust based on labs and organ function (often reducing or withholding copper and manganese in cholestasis, for example).
Monitoring
For patients on ongoing PN, clinicians commonly monitor:
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Trace element blood levels (or surrogate markers) when PN is long-term or when toxicity/deficiency is suspected
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Liver function/cholestasis markers (because copper/manganese can accumulate)
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Neurologic status when manganese exposure is a concern in long-term PN
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CBC/iron indices when copper status may affect hematologic parameters
- Clinical signs: wound healing, dermatitis, immune issues, hair/nail changes, taste changes, etc.
Safety considerations
Even though these are “micronutrients,” IV delivery bypasses normal gut regulation, so over-supplementation can occur if dosing isn’t adjusted.
Common high-risk scenarios:
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Cholestasis / hepatic impairment: increased risk of copper and manganese accumulation
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Long-term PN: risk of gradual accumulation or deficiency if not monitored and adjusted
-
Renal impairment: may influence trace element handling (particularly selenium, depending on clinical context and product)
Patients can also experience general IV/PN-related risks (not unique to Multrys):
- Infection risk (catheter-related)
- Admixture/compounding errors
- Hypersensitivity is uncommon but possible with injectable products
Packaging
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Each vial contains 1 mL of Multrys (single-dose)
-
25 vials are supplied in one carton/box
Typical operational implications:
- Single-dose vials are usually intended to be entered once and any unused portion discarded per sterile practice.
- Pharmacy typically uses these vials during PN compounding.
Storage and handling
Exact storage wording should be taken from the carton/insert, but injectable trace element vials commonly specify:
- Controlled room temperature storage (typical for many injectables)
- Protection from excessive heat/light as labeled
- Do not use if particulate matter/discoloration is present
- Do not use beyond expiration date
Buy Multrys Trace Elements Injection with Zinc, Copper, Manganese, Selenium here at Mountainside Medical Equipment.
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