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Lookup NU author(s): Colette Kirk, Professor Chris LambORCiD, Dr Nicholas Thompson
© 2019 American Society for Parenteral and Enteral Nutrition. 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.
Author(s): Kirk C, Gemmell L, Lamb CA, Thompson NP, Mountford CG, Toole BJ
Publication type: Article
Publication status: Published
Journal: Nutrition in Clinical Practice
Year: 2019
Volume: 35
Issue: 6
Pages: 1138-1142
Print publication date: 01/12/2020
Online publication date: 22/10/2019
Acceptance date: 29/09/2019
Date deposited: 03/10/2019
ISSN (print): 0884-5336
ISSN (electronic): 1941-2452
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1002/ncp.10431
DOI: 10.1002/ncp.10431
PubMed id: 31642109
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