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Massive intravenous manganese overdose due to compounding error: minimal role for hemodialysis

Elizabeth Quaal Hines1,2, Irfana Soomro3, Mary Ann Howland1,2,4

  • 1a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , NYU School of Medicine , New York , NY , USA ;

Clinical Toxicology (Philadelphia, Pa.)
|May 11, 2016
PubMed
Abstract

Insights

Acute manganese poisoning can cause irreversible neurological damage. Hemodialysis showed limited effectiveness in enhancing manganese elimination in this case, highlighting the importance of chelation therapy.

Area of Science:

  • Neurology
  • Toxicology
  • Nephrology

Background:

  • Manganese-associated parkinsonism is recognized in occupational settings, methcathinone users, and patients on long-term parenteral nutrition.
  • This study details a unique case of acute intravenous manganese poisoning.

Observation:

  • A 52-year-old woman received an 800 mg intravenous dose of manganese chloride.
  • She underwent hemodialysis and calcium disodium EDTA chelation therapy.
  • Initial blood manganese was 120 mcg/L, decreasing to 20 mcg/L post-hemodialysis, with minimal manganese elimination via dialysis.

Findings:

  • Hemodialysis removed only approximately 1.4% of the total manganese burden.
  • Despite reduced blood manganese levels, MRI revealed T1 hyperintensities in the globus pallidi, indicative of manganese exposure.
  • Manganese poisoning is linked to irreversible neurological toxicity.

Implications:

  • Hemodialysis may not significantly enhance manganese elimination in acute poisoning.
  • Chelation therapy remains a crucial component of supportive care.
  • This case underscores the potential for severe neurological consequences from acute manganese overexposure.
Keywords:
Adverse drug eventcompoundinghemodialysismanganeseparkinsonism

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