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Manganese Encephalopathy as a Complication of Parenteral Nutrition in the Intensive Care Unit

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Diet and Nutrition in Critical Care

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Abstract

Manganese encephalopathy can occur as a result of occupational exposure and as an unusual complication of parenteral nutrition seen usually in critically ill patients. Diagnosis requires a high index of suspicion as the classic symptoms (parkinsonism) are difficult to elicit in critically ill patients. Risk factors for manganese encephalopathy have been identified and clinicians should be mindful of them. There is a poor correlation between manganese levels and clinical findings and between response to therapy and residual imaging changes. Reliable biomarkers to determine manganese status and to detect Mn toxicity are not widely available. Treatment strategies include stopping the offending agent, using dopamine agonists, and possibly using chelating agents.

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Abbreviations

BBB:

Blood–brain barrier

CSF:

Cerebrospinal fluid

EDTA:

Ethylenediaminetetraacetic acid

EN:

Enteral nutrition

Mn:

Manganese

MRI:

Magnetic resonance imaging

PN:

Parenteral nutrition

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Emergency Medicine, Department of Neurosciences, Medical University of South Carolina, 169 Ashley Avenue MSC 300, Room H265, Charleston, SC, 29425, USA

    Charles M. Andrews

  2. Department of Nutrition Services, Medical University of South Carolina, 169 Ashley Avenue, Suite EH110B MSC905, Charleston, SC, 29425, USA

    Christine M. Martin

  3. Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 301 MSC 606, Charleston, SC, 29425, USA

    Julio A. Chalela

Authors
  1. Charles M. Andrews
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  2. Christine M. Martin
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  3. Julio A. Chalela
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Corresponding author

Correspondence to Charles M. Andrews .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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© 2014 Springer Science+Business Media New York

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Andrews, C.M., Martin, C.M., Chalela, J.A. (2014). Manganese Encephalopathy as a Complication of Parenteral Nutrition in the Intensive Care Unit. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_83-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_83-1

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  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-8503-2

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