Manganese Toxicity

Manganese is a trace element that serves as a coenzyme in multiple biochemical reactions. Manganese usually is supplied in PN admixtures as part of the trace element package in an adult dose of 0.5 mg/day; however, this may be excessive for longer-term PN patients. Manganese accumulation can occur in patients with cholestasis, and the most common toxicity is neurotoxicity, but liver toxicity also may occur. Neurologic symptoms associated with manganese toxicity include headache, somnolence, weakness, confusion, tremor, muscle rigidity, altered gait, and mask-like face

(a Parkinson's-like syndrome). Conversely, some patients with hypermanganesemia may not exhibit symptoms of toxicity. Periodic measurement of blood-manganese concentrations in patients on long-term PN is recommended. Patients with cholestasis receiving PN may require restriction of manganese in PN to prevent its accumulation and possible toxicity.

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