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Manganese toxicity in critical care: Case report, literature review and recommendations for practice

Edward Walter1, Sinan Alsaffar1, Callum Livingstone2

  • 1Department of Intensive Care, Royal Surrey County Hospital, Surrey, UK.

Journal of the Intensive Care Society
|October 6, 2017
PubMed

Insights

A patient receiving parenteral nutrition developed manganese toxicity, leading to neurological symptoms like tremor and dyskinesia. This case highlights the importance of monitoring manganese levels in patients on long-term nutrition support.

Area of Science:

  • Clinical Medicine
  • Neuroscience
  • Nutritional Science

Background:

  • Parenteral nutrition (PN) is a life-sustaining treatment for intestinal failure.
  • Manganese is an essential trace element, but excess can lead to toxicity.
  • Long-term PN can alter trace element metabolism and increase toxicity risk.

Observation:

  • A 62-year-old male patient in the ICU with pancreatitis received prolonged PN.
  • Elevated whole blood manganese concentrations were observed after 2.5 months of PN.
  • The patient subsequently developed resting tremor and extra-pyramidal dyskinesia.

Findings:

  • Hypermanganesaemia was presumed to be the cause of the patient's neurological symptoms.
  • The neurological presentation was distinct, with no other neurological deficits.
  • This case underscores a potential link between PN and manganese neurotoxicity.

Implications:

  • Routine monitoring of manganese levels in patients on long-term PN may be warranted.
  • Further research into manganese metabolism and safe dosage in PN is needed.
  • Clinical guidelines for trace element management in PN may require updates.
Keywords:
Parenteral nutritioncritical caremanganese toxicitymonitoring

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