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

• Published in: Nutrition in clinical practice 2020-12, Vol.35 (6), p.1138-1142
• Main Authors: Kirk, Colette, Gemmell, Lisa, Lamb, Christopher A., Thompson, Nick P., Mountford, Christopher G., Toole, Barry J.
• Format: Article
• Language: English
• Subjects: home parenteral nutrition; manganese; Nursing; Parkinson disease; trace elements
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1002/ncp.10431

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.