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Hypermanganesemia in an acute care setting

Kelly O'Donnell1, Amy Radigan

  • 1University of Virginia Health System, Digestive Health Center, Charlottesville, VA 22908-0673, USA. kab5cb@virginia.edu

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
|October 11, 2005
PubMed

Insights

Long-term parenteral nutrition patients may develop manganese toxicity due to trace element supplementation. Removing manganese from the solution improved neurologic symptoms and lowered blood manganese levels.

Area of Science:

  • Clinical Medicine
  • Nutritional Science
  • Toxicology

Background:

  • Hypermanganesemia is a concern in patients on long-term home parenteral nutrition (PN) with trace element supplementation.
  • Manganese homeostasis relies on intestinal absorption and biliary excretion, posing risks for PN patients, particularly those with liver dysfunction.
  • Neurologic symptoms can manifest in patients with elevated manganese levels.

Purpose of the Study:

  • To report a case of manganese toxicity in a patient receiving long-term parenteral nutrition.
  • To highlight the potential risk of manganese accumulation in PN patients, especially those with hepatic dysfunction.
  • To demonstrate the efficacy of manganese removal in resolving toxicity symptoms.

Main Methods:

  • A case study of a patient receiving PN for 7 months was conducted.
  • Whole blood manganese levels were measured to assess toxicity.
  • Manganese was removed from the patient's trace element solution.
  • Clinical symptoms and blood manganese levels were monitored post-intervention.

Main Results:

  • The patient presented with neurologic symptoms and a whole blood manganese level nearly three times the normal range.
  • Following the elimination of manganese from the PN solution, blood manganese levels significantly decreased.
  • Marked improvement in neurologic symptoms, including facial paralysis and headaches, was observed.

Conclusions:

  • Long-term parenteral nutrition patients are at risk for hypermanganesemia and manganese toxicity.
  • Hepatic dysfunction may exacerbate the risk of manganese accumulation in PN patients.
  • Eliminating manganese from trace element solutions can effectively manage and resolve manganese toxicity.

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