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Brain Manganese Deposition and Blood Levels in Patients Undergoing Home Parenteral Nutrition

Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Unità Operativa Autonoma di Dietetica e Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy, rizzetto{at}molinette.unito.it

Marco Tinivella, MD

Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Unità Operativa Autonoma di Dietetica e Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Federico Alessandro Balzola, MD

Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Unità Operativa Autonoma di Dietetica e Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Antonella de Francesco, MD

Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Unità Operativa Autonoma di Dietetica e Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Ottavio Davini, MD

Unità Operativa Autonoma di Radiologia Diagnostica I, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Laura Rizzo, MD

Unità Operativa Autonoma di Radiologia Diagnostica I, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Paola Massarenti, PhD

Dipartimento di Patologia Clinica e Laboratorio Analisi, Laboratorio di Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Maria Antonietta Leonardi

Dipartimento di Patologia Clinica e Laboratorio Analisi, Laboratorio di Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Franco Balzola, MD

Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Unità Operativa Autonoma di Dietetica e Nutrizione Clinica, Azienda Ospedaliera San Giovanni Battista, Torino, Italy

Background : Extrapyramidal syndrome and alterations in brain magnetic resonance images are described in patients undergoing long-term home parenteral nutrition (HPN) and in cholestatic patients. These abnormalities have been correlated to basal ganglia manganese (Mn) accumulation. Methods: A longitudinal 1-year study was conducted on 15 patients undergoing HPN (median duration, 3.8 years; range, 1.7-10; median Mn parenteral supplementation, 0.1 mg/d). Whole-blood, plasma, intra-erythrocytes, and urinary Mn concentrations were measured and brain magnetic resonance was performed at the beginning (time 0) and after 1 year of Mn intravenous supplementation withdrawal (time 1). No patients showed psychosis, extrapyramidal syndrome, or cholestasis. Results: At time zero, 10 of 15 patients (67%) showed paramagnetic accumulation on cerebral magnetic resonance images; at time 1 there was a reduction of cerebral Mn accumulation. In all patients, blood-Mn levels were significantly reduced after 1 year of Mn intravenous supplementation withdrawal. Conclusions: Patients receiving long-term HPN showed an elevated incidence of alterations in brain magnetic resonance images with a median Mn intravenous supplementation of 0.1 mg/d. Mn supplementation withdrawal significantly decreased metal levels in blood and brain storage. We noticed that the intra-erythrocyte Mn level was a good index of Mn status. (Journal of Parenteral and Enteral Nutrition 24:223-227, 2000)

Journal of Parenteral and Enteral Nutrition, Vol. 24, No. 4, 223-227 (2000)
DOI: 10.1177/0148607100024004223


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