Hypermanganesemia in long-term intravenous nutrition and chronic liver disease.
BACKGROUND
Hypermanganesemia and cholestatic liver disease are both recognized complications of long-term IV nutrition. Manganese is primarily excreted in bile, and recent studies have indicated that manganese toxicity may play a role in the pathogenesis of IV nutrition-associated cholestasis.


METHODS
Whole blood and plasma manganese concentrations were measured in patients receiving long-term home IV nutrition (HIN, n = 30). Whole blood manganese concentrations also were measured in patients with chronic liver disease (CLD, n = 10) and control subjects (n = 10).


RESULTS
Whole blood manganese concentrations of all CLD patients were within the reference interval (73 to 210 nmol/L) and were not different from those of the control group (151 +/- 44 nmol/L, CLD vs 155 +/- 35 nmol/L, control; not significant), despite the presence of cholestasis. In contrast, whole blood manganese concentration was increased (>210 nmol/L) in 26 patients, and plasma manganese concentration increased (>23 nmol/L) in 23 of the patients receiving HIN. None of the patients exhibited neurologic signs of manganese toxicity. There was no correlation between whole blood manganese concentrations and markers of cholestasis, IV manganese intake, or duration of HIN. However, plasma manganese concentration correlated both with average weekly IV manganese intake (r = .44, p = .02) and with gamma-glutamyl transferase (r = .43, p = .02) and alkaline phosphatase activities (r = .55, p = .003).


CONCLUSIONS
Cholestatic liver disease does not appear to contribute to increased whole blood manganese concentrations in patients not receiving HIN. Plasma manganese concentrations in patients receiving HIN reflect recent manganese exposure and impaired excretion where cholestasis is present. The lack of relationship between plasma and whole blood manganese concentrations suggests that factors other than manganese intake and excretion affect intracellular concentrations.
Wardle
C A
CA
Department of Clinical Chemistry, Royal Liverpool University Hospitals NHS Trust, United Kingdom.
Forbes
A
A
Roberts
N B
NB
Jawhari
A V
AV
Shenkin
A
A
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000097:blood*; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D005723:gamma-Glutamyltransferase / Q000097:blood
D008345:Manganese; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase