title: Is manganese an essential supplement for parenteral nutrition?
abstract: OBJECTIVE
  To summarize the role of the essential trace element, manganese, its potential toxicity, monitoring methods and dosage recommendations for nutrition support.
  
  
  RESULTS
  Parenteral nutrition usually contains manganese as part of a fixed concentration multiple trace element supplement. Recent literature identifies potential problems in this approach and reports toxic symptoms resulting from hypermanganesaemia in paediatric and long-term home patients. Elimination by the hepatobiliary system is frequently impaired, and parenteral administration bypasses the regulatory mechanisms of homeostasis. Together with occasional oral intake and product contamination, this can lead to brain accumulation and neurotoxicity, with individual responses to supplementation difficult to predict. Regular monitoring is recommended, but plasma and serum analyses are poor indicators of body stores. Whole blood concentrations are more accurate and correlate with signal intensity of MRI. We have identified a need for individual trace element additives to be more widely available and for multitrace element products to be reformulated. There is now a persuasive argument for not routinely adding manganese to parenteral nutrition admixtures.
  
  
  CONCLUSIONS
  High intravenous doses of manganese can lead to neurotoxicity. Current dosage guidelines and trace element formulations need revision. Frequent monitoring to identify tissue accumulation is recommended for paediatric and long-term home parenteral nutrition patients.
authors.affiliation: Faculty of Medical and Heath Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Ines J
authors.initials: IJ
authors.lastname: Hardy
authors.forename: Lyn
authors.initials: L
authors.lastname: Gillanders
authors.forename: Gil
authors.initials: G
authors.lastname: Hardy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008134:Long-Term Care; D008297:Male; D008345:Manganese / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D020149:Manganese Poisoning / Q000209:etiology* / Q000517:prevention & control; D010288:Parenteral Nutrition / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D013997:Time Factors
chemical_list: D008345:Manganese