Factors associated to hypermanganesemia in patients receiving home parenteral nutrition.
BACKGROUND
Home parenteral nutrition (HPN) patients often present hypermanganesamia.


OBJECTIVE
To examine which factors may be associated to hypermanganesemia in HPN patients.


METHODS
Plasma manganese (Mn), liver function tests, C-reactive protein concentrations, erythrocyte sedimentation rate (ESR), tumor necrosis factor-alpha (TNF- alpha), interleukin-6, soluble receptors of interleukin-2, and blood neopterin concentrations were determined in 21 HPN patients and 10 healthy controls. Brain magnetic resonance imaging (MRI) and careful neurologic clinical examination were performed in 11 patients.


RESULTS
Mn concentration was higher in HPN patients than controls (1.96+/-1.1 vs 0.81+/- 0.4 microg/L;P<0.001) and positively correlated to the amount of parenteral nutrition (PN) supply, transaminases and alkaline phosphatase (r=0.53, P<0.0001) concentrations, as well as to ESR (r=0.61, P<0.0001), TNF- alpha and blood neopterin. The amount of calories provided by PN was positively correlated to inflammatory markers and liver parameters. All patients investigated by MRI showed hyperintense basal ganglia on T1-weighted images suggesting brain Mn deposition. Only one had slight clinical extrapyramidal symptoms.


CONCLUSIONS
In HPN patients, sustained inflammation may facilitate hypermanganesemia through 1. cholestatic liver disease and thereby decreased Mn biliary excretion, 2. high nutritional requirements (responsible for increased Mn supply), and/or 3. modified Mn metabolism or body distribution. Neurologic complications appeared marginal whereas Mn brain deposition seems frequent.
Reimund
J M
JM
Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France.
Dietemann
J L
JL
Warter
J M
JM
Baumann
R
R
Duclos
B
B
D000328:Adult; D000368:Aged; D001799:Blood Sedimentation; D002097:C-Reactive Protein; D002779:Cholestasis / Q000150:complications; D005260:Female; D006801:Humans; D007378:Interleukins / Q000032:analysis; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000097:blood* / Q000378:metabolism; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D008345:Manganese; D019798:Neopterin; D002097:C-Reactive Protein