Appendix
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Internal Medicine

Chromium Deficiency

Trivalent chromium is considered an essential trace element for metabolizing lipids and carbohydrates. Some clinical trials suggest that it enhances the effect of insulin in peripheral tissues. Trivalent chromium is believed to be an essential component of metalloenzymes in metabolizing carbohydrates, proteins, and fats. Therefore, it is a recommended component of a regular diet in most individuals and an essential supplement for those on total parenteral nutrition. However, there has been debat

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • In current clinical practice, chromium deficiency is suspected in critically ill individuals who have unexplained glucose intolerance or escalating insulin requirements.
  • Acute infection has also been associated with decreased circulating chromium levels, which is believed to account for the hyperglycemia often observed in this setting.
  • Severe trauma, extensive burns, and short bowel syndrome can all lead to decreased chromium absorption and increased demand for chromium due to the alterations in catabolic and anabolic processes.
  • Chromium deficiency can be directly assessed by measuring plasma concentrations of chromium.
  • Urinary chromium levels have also been used in the past.
  • Another method of detecting chromium deficiency is measuring glucose tolerance after chromium administration.
  • When chromium deficiency is suspected, glucose tolerance testing before and after chromium administration is the preferred testing method for this disease.
  • Chromium supplementation is also recommended in enteral and parenteral nutrition.
  • When chromium deficiency is suspected based on insulin resistance, the recommended chromium supplementation dosage through parenteral nutrition solutions is 200 to 250 µg/d for 2 weeks.
  • Alternatively, intravenous chromium supplementation may be provided in dosages between 3 to 20 µg/h through a 10-hour infusion for a maximum of 4 days.
  • This recommendation is limited to critically ill individuals with insulin resistance.
  • An exception can be made for critically ill individuals with severe insulin resistance and hyperglycemia.
  • Chromium supplementation beyond adequate intake levels in patients without any evidence of chromium deficiency is not recommended.
  • Chromium supplementation for managing hyperglycemia and dyslipidemia in patients without any evidence of chromium deficiency is not recommended.
  • The American Diabetes Association states that there is insufficient data to support the use of chromium for glycemic control or to decrease the risk of diabetes in healthy individuals.
  • The United States Food and Drug Administration states that the relationship between chromium supplementation and insulin resistance or type 2 diabetes is highly uncertain.
  • The marketed benefit of chromium supplementation in reducing weight and increasing lean body mass is highly questionable.
  • Current guidelines recommend foregoing chromium supplementation in parenteral nutrition given to children or significantly reducing the dose to mitigate this complication.
  • Given the limitations of laboratory testing, routine use of chromium levels or glucose tolerance testing for monitoring is not recommended.
  • Even with critically ill patients on total parenteral nutrition, routine monitoring of chromium levels is not recommended.
  • Chromium deficiency has also been linked to high-inflammatory status (high-sensitivity C-reactive protein levels) and a potential increase in cardiovascular complications.
  • Clinical pharmacists and dieticians must note the recommended daily doses of chromium in total parenteral nutrition solutions and monitor renal functions to decrease the risk of toxicity in these individuals.
  • The nephrotoxic effects of chromium may be more pronounced in pediatric populations, where an inverse correlation between serum chromium levels and renal function has been described.
  • review
    Chromium Deficiency. StatPearls [Internet] — Soha Afzal, Gisela A. Ocasio Quinones — StatPearls Publishing, 2024

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov