PTH-212 High serum manganese levels in patients receiving long term total parenteral nutrition

Nair, Satheesh; Jeffray, C; Mountford, C; Thompson, NP

doi:10.1136/gutjnl-2015-309861.1100

Cited by 2 publications

(2 citation statements)

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“…In 2014, a previous review at our institution observed 60% of home PN (HPN) patients to have high whole‐blood Mn levels 14 . Practice was changed, and MTE solutions were subsequently removed from all HPN formulations in January 2015.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13] In 2014, a previous review at our institution observed 60% of HPN patients to have high whole-blood Mn levels. 14 Practice was changed and multi-trace element solutions were subsequently removed from all HPN formulations in January 2015. Rather, the trace elements zinc, selenium, iron and copper were added individually.…”

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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A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition

Baker,

French,

Hann

et al. 2024

J Human Nutrition Diet

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IntroductionHome parenteral nutrition (HPN) prescriptions should be individualised in adults with chronic intestinal failure (IF). The aims of the review were to explore HPN requirements and available guidelines and to determine whether adults (≥ 18 years) receive recommended parenteral nutrient doses.MethodsOnline databases searches identified empirical evidence (excluding case‐reports), reviews and guidelines (Published 2006–2024 in English language). Additional reference lists were hand‐searched. Older studies, cited in national guidelines were highlighted to map evidence source. Two reviewers screened 1660 articles independently, with 98 full articles assessed and 78 articles included (of which 35 were clinical studies). Citation tracking identified 12 older studies.ResultsA lack of evidence was found assessing parenteral macronutrient (amounts and ratios to meet energy needs), fluid and electrolyte requirements. For micronutrients, 20 case series reported serum levels as biomarkers of adequacy (36 individual micronutrient levels reported). Studies reported levels below (27 out of 33) and above (24 out of 26) reference ranges for single micronutrients, with associated factors explored in 11 studies. Guidelines stated recommended parenteral dosages. Twenty‐four studies reported variable proportions of participants receiving HPN dosages outside of guideline recommendations. When associated factors were assessed, two studies showed nutrient variation with type of HPN administered (multichamber or individually compounded bags). Five studies considered pathophysiological IF classification, with patients with short bowel more likely to require individualised HPN and more fluid and sodium.ConclusionsThis review highlights substantial evidence gaps in our understanding of the parenteral nutritional requirements of adult receiving HPN. The conclusions drawn were limited by temporal bias, small samples sizes, and poor reporting of confounders and dose. Optimal HPN nutrient dose still need to be determined to aid clinical decision‐making and further research should explore characteristics influencing HPN prescribing to refine dosing recommendations.

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PTH-212 High serum manganese levels in patients receiving long term total parenteral nutrition

Cited by 2 publications

References 0 publications

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

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

A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition

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