Effect of Discontinuation of Manganese Supplementation From Home Parenteral Nutrition Solutions on Whole‐Blood Levels and Magnetic Resonance Imaging of the Brain: A 5‐Year Cohort Study

Jin, Jennifer; Saqui, Olivia; Allard, Johane P.

doi:10.1177/0148607117690519

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…Patients with PNAC are at an even higher risk because the function of the hepatobiliary system is reduced and therefore is not able to effectively excrete manganese through bile. Hypermanganesemia may also be a potential cause of cholestatic liver disease 81 , 82 …”

Section: Long‐term Metabolic Complicationsmentioning

confidence: 99%

“…Serum or plasma manganese is also available to order at many laboratories but is not recommended. A study by Jin et al 82 investigated manganese levels in 11 HPN patients. They found all patients had a decrease in whole‐blood manganese level on repeat measure, and most were able to maintain normal levels over a 5‐year period when manganese was removed from PN solutions.…”

Section: Long‐term Metabolic Complicationsmentioning

confidence: 99%

“…Hypermanganesemia may also be a potential cause of cholestatic liver disease. 81,82 Effective monitoring strategies to reduce occurrence. Manganese levels should be checked at the start of HPN and then every 3 months along with the other trace elements.…”

Section: Manganese Toxicitymentioning

confidence: 99%

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Metabolic Complications of Home Parenteral Nutrition

Davila

Konrad

2017

Nut in Clin Prac

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Home parenteral nutrition (HPN) has benefited countless patients since its initiation almost 5 decades ago. Over time, HPN has been found to be associated with various complications, including metabolic disorders. Metabolic complications can be grouped into short-term (eg, fluid imbalance, electrolyte disturbances, glucose abnormalities) and long-term (eg, hepatobiliary disorders, metabolic bone disease, iron deficiency anemia, manganese toxicity) categories. There are a number of treatment options for each complication. It is important to evaluate the entire clinical picture prior to initiating an intervention and use evidence-based interventions when available. A dedicated multidisciplinary team is best suited to prevent and manage complications when they are identified.

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Section: Long‐term Metabolic Complicationsmentioning

confidence: 99%

Section: Long‐term Metabolic Complicationsmentioning

confidence: 99%

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Metabolic Complications of Home Parenteral Nutrition

Davila

Konrad

2017

Nut in Clin Prac

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“…100 This can be associated with neuropsychiatric symptoms and parkinsonism, 101 which can be reversed upon removing Mn from PN. 102 The newer commercial MTE available in some parts of the world have lower amounts of Mn compared with previous solutions, and this needs to be considered.…”

Section: Rationalementioning

confidence: 99%

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper

Blaauw

Osland

Sriram

et al. 2019

J Parenter Enteral Nutr

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Background Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines’ recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. Methods Based on the available evidenced‐based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. Results The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. Conclusion Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision—including voluntary omission, partial provision, and supply issues—must be overcome to allow safe and responsible nutrition practice.

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“…Mn is typically provided as part of a commercially available pre-mixed multi-trace element (MTE) solution in all patients receiving parenteral nutrition (PN). Additional Mn exposure is known to occur as a result of contamination via PN additives, 7 likely at a level to meet requirements. 8 Recommended standard doses of Mn in PN for adults have been decreasing (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Elevated Whole‐Blood Manganese Levels in Adult Patients Prescribed “Manganese‐Free” Home Parenteral Nutrition

et al. 2019

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Background: Manganese toxicity can occur as a complication of home parenteral nutrition (HPN). Patients can present with Parkinson disease-like symptoms. Preparations of trace elements (TEs) in parenteral nutrition (PN) generally provide amounts in excess of requirements. Our previous review observed 60% of adult HPN patients had high whole-blood manganese levels. Multi-TE (MTE) solutions were subsequently removed from all HPN formulations in January 2015. The aim of this evaluation was to determine whole-blood concentrations of manganese in adult patients receiving HPN to establish whether levels are now maintained within the normal reference range. Methods: A retrospective review of whole-blood manganese levels in all patients receiving HPN between January 2018 and January 2019 from 1 hospital site was carried out. Results: 100 patients were included in the review (59 female and 41 male). Normal whole-blood manganese levels (73-219 nmol/L) were observed in 70% of patients and elevated levels (>219 nmol/L) in 30% of patients. In the patients with elevated levels, 57% had not received manganese supplementation for at least 1 year prior to manganese being measured. Markers of cholestasis were similar between the 2 groups. Conclusions: Incidence of elevated whole-blood manganese concentrations in patients receiving HPN decreased from 60% to 30% upon discontinued use of an MTE solution. Elevated levels remain a concern despite patients being prescribed "manganese-free" PN. Patients receive this TE in amounts adequate to meet requirements through contamination and dietary intake alone, suggesting additional parenteral supplementation of manganese is not required.

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Effect of Discontinuation of Manganese Supplementation From Home Parenteral Nutrition Solutions on Whole‐Blood Levels and Magnetic Resonance Imaging of the Brain: A 5‐Year Cohort Study

Abstract: Removal of Mn as an additive in HPN solutions resulted in resolution of MRI abnormalities in most patients. Over 5 years, all patients except for 1 maintained normal blood Mn levels. Therefore, Mn levels should be monitored and supplementation be individualized.

Cited by 9 publications

References 30 publications

Metabolic Complications of Home Parenteral Nutrition

Metabolic Complications of Home Parenteral Nutrition

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper

Elevated Whole‐Blood Manganese Levels in Adult Patients Prescribed “Manganese‐Free” Home Parenteral Nutrition

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