Parenteral nutrition manganese toxicity

When oral intake is precluded, the recommended daily parenteral supplementation of manganese is 0.15-0.8 mg. Manganese is mainly excreted in the bile during cholestasis serum manganese levels may rise, and manganese toxicity can result. Hjq)ermanganesemia after parenteral nutrition when first reported was linked to portosystemic encephalopathy. Patients with liver disease were particularly at risk. 

Taylor S, Manara AR. Manganese toxicity in a patient with cholestasis receiving total parenteral nutrition. Anaesthesia 1994 49(11) 1013. 

Mehta R, Reilly JJ. Manganese levels in a jaundiced longterm total parenteral nutrition patient potentiation of haloperidol toxicity Case report and literature review. J Parenter Enteral Nutr 1990 14(4) 428-30. 

FeU JM, Reynolds AP, Meadows N, Khan K, Long SG, Quaghebeur G et al. Manganese toxicity in children receiving long-term parenteral nutrition. Lancet 1996 347 1218-21. 

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