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manganese sulfate + zinc sulfate + cupric sulfate + selenious acid is an injectable fixed-dose combination trace element product for use as an additive to parenteral nutrition solutions. Marketed by American Regent under the brands Tralement for adults and pediatric patients weighing at least 10 kg and Multrys for neonatal and pediatric patients weighing less than 10 kg, it supplies four essential micronutrients: zinc, copper, manganese, and selenium. Its pharmacologic effect is nutritional replacement rather than receptor-mediated drug action; these trace elements function as essential cofactors for enzymes involved in antioxidant defense, immune function, wound healing, connective tissue formation, iron metabolism, growth, and cellular metabolism. It is indicated when oral or enteral nutrition is not possible, insufficient, or contraindicated, and it is not administered by direct intravenous infusion but only as an admixture in a parenteral nutrition solution.
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