What is the maximal daily dose of chromium?

Maximal Daily Dose of Chromium

For general nutrition, the maximal safe daily dose of chromium is 35 μg/day for enteral nutrition and 10 μg/day for parenteral nutrition, with therapeutic doses up to 1000 μg/day being used safely in specific clinical scenarios. 1

Standard Recommended Doses

The European Society for Clinical Nutrition and Metabolism (ESPEN) provides clear guidelines on chromium supplementation:

• Enteral nutrition: At least 35 μg/day with 1500 kcal/day 1
• Parenteral nutrition: At least 10 μg/day 1

These doses have been used safely and effectively in adults for many years, though the requirements in parenteral nutrition are still debated due to chromium's low absorption rate.

Therapeutic Doses for Specific Conditions

Higher doses may be used in specific clinical scenarios:

1. For suspected chromium deficiency in parenteral nutrition patients:

   • 200-250 μg/day IV for 2 weeks 1
   • Reassess insulin resistance after this period

2. For severe insulin resistance in critically ill patients:

   • 3-20 μg/hour IV for 10 hours (up to 4 days) 1
   • Only applicable to ICU patients requiring very high insulin doses (30-50 U/h)
   • Limited to a 4-day trial

Safety Considerations

• Chromium toxicity from oral supplementation is rare due to low absorption (0.4-2.5%) 1

• Parenteral chromium may have higher potential toxicity, especially in:

  • Pediatric patients
  • Patients with renal impairment (reduce dose)
  • Patients with abnormal liver function

• High levels of chromium have been found in patients on long-term parenteral nutrition, but no reported cases of toxicity in adults suggest these concentrations may not be harmful 1

Important Caveats

• Avoid for glycemic control in non-critical patients: Chromium supplementation should not be used to improve glycemia and dyslipidemia control in patients with type 2 diabetes, obesity, or non-diabetic patients 1

• Contamination in parenteral solutions: Chromium contaminants in parenteral nutrition solutions can increase the delivered amount by 10-100%, particularly from dextrose solutions 1

• Monitoring: Regular monitoring of chromium status is not recommended except when clinical suspicion of deficiency or toxicity exists 1

• Higher therapeutic doses: While some research has shown benefits with doses up to 1000 μg/day in type 2 diabetes 2, 3, these exceed the standard recommended intake but have been used without documented toxicity in nutritional studies 4

The safety range for trivalent chromium is very large, with no documented signs of toxicity in nutritional studies at levels up to 1000 μg per day 4, though standard supplementation should adhere to the ESPEN guidelines of 35 μg/day for enteral and 10 μg/day for parenteral nutrition 1.