Is manganese an essential supplement for parenteral nutrition?

Hardy, Ines; Gillanders, Lyn; Hardy, Gil

doi:10.1097/mco.0b013e3282f9e889

Cited by 59 publications

(55 citation statements)

References 40 publications

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“…Recent understanding of the adverse effects of hypermanganesemia on the liver and brain has led some to question its routine supplementation in PN-dependent neonates [51]. Biliary excretion of Mn is impaired in neonates and predisposes them to Mn toxicity when PN is administered.…”

Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

“…Many experts recommend dosing Mn in PN solutions on an individual basis rather than as ad hoc trace element combination mixtures ( Table 3) that do not allow for fine tuning of individual trace element requirements, because most trace element packages commercially available provide Mn in doses 5 times higher than recommended [51,52]. However, that makes the formulation of PN solutions incredibly difficult for hospital pharmacies.…”

Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

“…It often takes several weeks for the high Mn levels to normalize after discontinuation of supplementation. It should, however, be considered that Mn toxicity can still occur because the element is a common contaminant in PN solutions [51]. There is one report that suggests that the contaminant level of Mn in PN alone is sufficient to meet estimated requirements without additional supplementation [52].…”

Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

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Role of trace elements in parenteral nutrition support of the surgical neonate

Burjonrappa

Miller

2012

Journal of Pediatric Surgery

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Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

Section: Supplementation and Monitoring Of Levelsmentioning

confidence: 99%

See 1 more Smart Citation

Role of trace elements in parenteral nutrition support of the surgical neonate

Burjonrappa

Miller

2012

Journal of Pediatric Surgery

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“…For clinical practice, the availability of a substitution mixture of trace elements lacking Mn would be advantageous [12,13,14,15]. …”

Section: Discussionmentioning

confidence: 99%

Trace Element Status (Zinc, Copper, Selenium, Iron, Manganese) in Patients with Long-Term Home Parenteral Nutrition

Dastych

Šenkyřík²,

Novák³

et al. 2016

Ann Nutr Metab

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Background: The objective of the present study was to determine concentrations of zinc (Zn), copper (Cu), iron (Fe), selenium (Se) in blood plasma and manganese (Mn) in the whole blood in patients with long-term home parenteral nutrition (HPN) in comparison to the control group. Patients and Methods: We examined 68 patients (16 men and 52 women) aged from 28 to 68 years on a long-term HPN lasting from 4 to 96 months. The short bowel syndrome was an indication for HPN. The daily doses of Zn, Cu, Fe, Se and Mn in the last 3 months were determined. Results: No significant differences in blood plasma were found for Zn, Cu and Fe in patients with HPN and in the control group (p > 0.05). The concentration of Mn in whole blood was significantly increased in HPN patients (p < 0.0001), while Se concentration in these patients was significantly decreased (p < 0.005). The concentration of Mn in the whole blood of 16 patients with cholestasis was significantly increased compared to the patients without cholestasis (p < 0.001). The Cu concentration was increased with no statistical significance. Conclusion: In long-term HPN, the status of trace elements in the patients has to be continually monitored and the daily substitution doses of these elements have to be flexibly adjusted. Dosing schedule needs to be adjusted especially in cases of cholestatic hepatopathy. A discussion about the optimal daily dose of Mn in patients on HPN is appropriate. For clinical practice, the availability of a substitution mixture of trace elements lacking Mn would be advantageous.

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“…Manganese neurotoxicity, or manganism, initially characterized by a psychiatric disorder resembling schizophrenia, shares neuropathologies with several clinical disorders, in particular Parkinson's disease [2]. Manganese intoxication occurs from occupational exposures [3], administration of total parenteral nutrition [4], and chronic liver failure [5]. Manganese exposure has also focused on the use of a Mn-containing fuel additive, methylcyclopentadienyl manganese tricarbonyl, as an antiknock agent in gasoline in Canada and other Western nations [6].…”

Section: Introductionmentioning

confidence: 99%

Manganese exposure alters the expression of N‐methyl‐d‐aspartate receptor subunit mRNAs and proteins in rat striatum

Deng

2010

J Biochem & Molecular Tox

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Manganese is one of the ubiquitous environmental pollutants that can induce an indirect excitotoxicity caused by altered glutamate (Glu) metabolism. The present study has been carried out to investigate the effect of Mn on the expression of N-methyl-d-aspartate receptor (NR) subunit mRNAs and proteins in rat striatum when rats were in manganism. The rats were divided randomly into four groups of six males and six females each: control group (group 1) and 8, 40, and 200 micromol/kg Mn-treated groups (groups 2-4). The control group rats were subcutaneously (s.c.) injected with normal saline. Manganese-treated rats were s.c. injected with respectively 8, 40, and 200 micromol/kg of MnCl(2) . 6H(2)O in normal saline. The administration of MnCl(2) . 6H(2)O for 4 weeks significantly increased Mn concentration in the striatum. With the increase in administered MnCl(2) dosage, Glu concentration and cell apoptosis rate increased significantly. The relative intensity of NR2A mRNA decreased significantly in 8 micromol/kg Mn-treated rats. However, relative intensities of NR1 and NR2B mRNAs decreased significantly in 40 micromol/kg Mn-treated rats. Similarly, the relative intensity of NR2A protein showed a significant decrease in 40 micromol/kg Mn-treated rats whereas those of NR1 and NR2B decreased significantly in 200 micromol/kg Mn-treated rats. Therefore, the expression of NR2A mRNA and protein were much more sensitive to Mn than that of NR1 and NR2B. In conclusion, the results suggested that Mn induced nerve cell damage by increasing extracellular Glu level and altered expression of NR subunit mRNAs and proteins in rat striatum.

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Is manganese an essential supplement for parenteral nutrition?

Abstract: 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.

Cited by 59 publications

References 40 publications

Role of trace elements in parenteral nutrition support of the surgical neonate

Role of trace elements in parenteral nutrition support of the surgical neonate

Trace Element Status (Zinc, Copper, Selenium, Iron, Manganese) in Patients with Long-Term Home Parenteral Nutrition

Manganese exposure alters the expression of N‐methyl‐d‐aspartate receptor subunit mRNAs and proteins in rat striatum

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