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Manganese requirement and toxicity in patients on home parenteral nutrition

N Reynolds1, A Blumsohn, J P Baxter

  • 1Department of Digestive Disease and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee, UK.

Clinical Nutrition (Edinburgh, Scotland)
|April 17, 1999
PubMed

Insights

Home parenteral nutrition may lead to manganese toxicity, causing neurological symptoms. Elevated manganese levels and brain deposition were observed in some patients, highlighting variability in susceptibility.

Area of Science:

  • Clinical Medicine
  • Neuroscience
  • Toxicology

Background:

  • Home parenteral nutrition (HPN) is a life-sustaining therapy for patients with gastrointestinal failure.
  • Neurological symptoms can arise in patients on HPN, necessitating investigation into potential causes.
  • Trace elements, including manganese, are essential but can be toxic at elevated levels.

Purpose of the Study:

  • To investigate the potential link between home parenteral nutrition and manganese toxicity.
  • To evaluate neurological symptoms in HPN patients with elevated plasma manganese concentrations.
  • To assess for brain manganese deposition using magnetic resonance imaging (MRI).

Main Methods:

  • Clinical appraisal of HPN patients presenting with neurological symptoms.
  • Measurement of plasma manganese concentrations.
  • Brain MRI scanning to detect manganese deposition.
  • Evaluation of all HPN patients for manganese toxicity.

Main Results:

  • Two HPN patients presented with neurological symptoms and elevated plasma manganese levels.
  • Three out of nine HPN patients evaluated had plasma manganese concentrations exceeding twice the normal upper limit.
  • MRI scans revealed manganese deposition in the brains of patients with elevated manganese levels.
  • Patients showed variable susceptibility to manganese toxicity.

Conclusions:

  • Elevated manganese levels in HPN patients can lead to neurological symptoms and brain deposition.
  • Trace element content in parenteral nutrition solutions may be a source of manganese toxicity.
  • Individual susceptibility to manganese toxicity varies, complicating safe trace element administration.

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