Evaluation of indexes of in vivo manganese status and the optimal intravenous dose for adult patients undergoing home parenteral nutrition

Abstract

Background: There are no accurate indexes for determining the status of manganese in humans, and there is no clear recommended daily dose of this essential trace element to be administered in total parenteral nutrition solutions. Objective: The objectives were to evaluate accurate indexes of manganese status and elucidate the optimal manganese dose to be administered to adult patients undergoing home parenteral nutrition. Design: Patients were administered total parenteral nutrition solutions providing 0, 1, 2, or 20 μmol Mn/d according to an on-off design, after which manganese concentrations in whole blood and plasma were determined. Magnetic resonance imaging (MRI) was performed to determine the intensity on T1-weighted images (MRI intensity) and T1 values in the globus pallidus. Hematologic and biochemistry tests were also performed. Results: High degrees of correlation were found between whole-blood manganese concentrations and both MRI intensity (r = 0.7728) and T1 values (r = -0.7519) in the globus pallidus. A strong negative correlation was found between MRI intensity and T1 values (r = -0.8407). The dose of 1 μmol Mn/d caused no change in MRI intensity or T1 values, and the whole-blood manganese concentration remained within the normal range in all patients. Conclusions: Whole-blood manganese concentrations and MRI intensity and T1 values in the globus pallidus are useful indexes of the status of manganese in humans. The optimal dose of manganese may be 1 μmol/d for adult patients undergoing home parenteral nutrition.