Table 1.
SELECTED REPORTS OF HYPERMANGANESEMIA IN PARENTERALLY FED ADULT PATIENTS
| Reference | n | Age Range | Disease | Mn daily dose and duration of intake | Laboratory Findings | Radiological Findings | Clinical Symptoms |
|---|---|---|---|---|---|---|---|
|
| |||||||
| Ejima et al. (1992) | 1 | 62 y | SBS | 2.2b mg (2.3 mo) | Incr WB Mn 3.0–5.6 μg/dL (normal range 0.4–2.0), decr after 15 wk of Mn-free PN | Incr MRI signal (basal ganglia, especially globus pallidus, tectum, and tegmentum of midbrain and pons); MRI signal decr after 22 wk of Mn-free PN. | Parkinsonism w/dysarthria, mild rigidity, hypokinesia, masked face, halting gate. |
| Mirowitz et al. (1991) | 9 | 51–74 y | numerous | 0.3–0.4 mg (mean PN duration 5.3 y, range 5 mo–11 y) | NR | Incr MRI signal (basal ganglia) | 5 pts w/neurologic symptoms: memory loss, confusion weakness, fatigue and imbalance. |
| Mirowitz and Westrich (1992 | 1 | 61 y | GI dyskinesia | 0.4 mg (PN duration 3 y) | NR | Incr MRI signal (globus pallidus); 12 mo after d/c Mn, complete regression MRI signals | No symptoms |
| Alves et al. (1997) | 1 | 63 y | SBS | 1–2 mg (PN duration 19 mo) | Incr serum Mn 114 nmol/L (normal range 10–40) and incr urine Mn 381 nmol/L (normal range 15–60 nmol/24 h) | Incr MRI signal (basal ganglia and white matter); 6 mo after d/c Mn, decr MRI signals | Gait disturbance, dystonic movements |
| Nagatomo et al. (1999) | 1 | 68 y | ulcerative colitis | 20 μmol (PN duration 3 mo) | Incr serum Mn 4.2 mg/dL (normal range 0.4–2.0 mg/dL) and incr urine Mn 9.0 mg/dL (normal range <2.0 mg/dL) | Incr MRI signal (basal ganglia) | Psychiatric symptoms and gait disturbance |
| 1 | 70 y | aspiration pneumonia | 20 μmol (PN duration 4 mo) | Incr serum Mn 5.1 mg/dL; urine Mn 1.0 mg/dL | Incr MRI signal (basal ganglia) | Progressive gait disturbance and confusion | |
| Fitzgerald et al. (1999) | 36 | NR | numerous | 500 μg (< 48h) | RBC Mn: low to normal | 3 selected cases of abnormal MRI | 1 pt was noted to exhibit petit mal seizures, vertigo, gait disturbances and peripheral neuropathy |
| 30 | NR | 500 μg (range 3–30 d) | |||||
| 21 | 14–87 y | 500 μg (range 36–5075 d) | Incr RBC Mn in 15/21 pts in pts w/PN > 37 d (normal range 11 to 23 μg/L) | ||||
| Bertinet et al. (2000) | 15 | 32–74 y | numerous | Median Mn suppl. 0.1 mg (median PN duration 3.8 y) | Decr WB Mn after 1 y of IV Mn withdrawal | 10/15 incr MRI signal (basal ganglia) at the beginning of the PN | No symptoms |
Conc-concentration, d/c - discontinuation, Decr - decreased, GI - gastrointestinal, h-hours, Incr - increased, mo - month, MRI - magnetic resonance imaging, NR - not reported, PN - parenteral nutrition, pts-patients, RBC - red blood cells, SBS - short-bowel disease, suppl. - supplementation, wk - weeks, w/o - without, w/- with, wt - weight, y-years.