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Manganese intoxication during intermittent parenteral nutrition: report of two cases
K Masumoto1, S Suita, T Taguchi
1Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Background And Methods:
The administration of trace elements is thought to be needed in patients receiving long-term parenteral nutrition. Recently, manganese intoxication or deposition was documented in such patients. We report two cases of manganese intoxication during intermittent parenteral nutrition including manganese. Manganese had been administered for 4 years at a frequency of one or two times per week in one case and for 5 years at a frequency of one or two times per month in the other case. Both cases showed mild symptoms with headache and dizziness. One case had mild hepatic dysfunction and the other did not. The whole-blood manganese level increased in one case, but not in the other case. T1-weighted magnetic resonance images revealed symmetrical high-intensity areas in basal ganglia and thalamus in both cases. After the administration of manganese was stopped, these symptoms all disappeared and the magnetic resonance images abnormalities gradually improved in both patients. Mild long-term manganese intoxication is thus considered to occur regardless of the frequency of using a manganese supplement.
Conclusions:
Patients should be carefully monitored when receiving long-term parenteral nutrition including manganese, even when the manganese dose is small and the frequency of receiving a manganese supplement is low.
Insights
Long-term parenteral nutrition with manganese can lead to intoxication, even with infrequent or low doses. Symptoms like headache and dizziness resolved after discontinuing manganese supplements.
Area of Science:
- Clinical Nutrition
- Trace Element Metabolism
- Neurotoxicology
Background:
- Parenteral nutrition (PN) often requires trace element supplementation.
- Manganese is a crucial trace element, but excessive levels can be toxic.
- Recent concerns highlight manganese deposition in patients on long-term PN.
Observation:
- Two cases of manganese intoxication during intermittent PN are presented.
- Patients received manganese supplements 1-2 times/week or 1-2 times/month for 4-5 years.
- Mild symptoms (headache, dizziness) and basal ganglia/thalamus MRI abnormalities were observed.
Findings:
- Manganese intoxication occurred despite infrequent supplementation and mild symptoms.
- Whole-blood manganese levels were not consistently elevated.
- MRI revealed characteristic symmetrical high-intensity lesions in the basal ganglia and thalamus.
Implications:
- Long-term PN patients receiving manganese require careful monitoring for intoxication.
- Even low-dose, infrequent manganese supplementation can pose a risk.
- Discontinuation of manganese led to symptom resolution and MRI improvement.