Manganese toxicity: Difference between revisions
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**IV Methcathinone | **IV Methcathinone | ||
*Readily crosses the blood brain barrier and can be seen concentrated in the basal ganglia, particularly the globus pallidus | *Readily crosses the blood brain barrier and can be seen concentrated in the basal ganglia, particularly the globus pallidus | ||
==Clinical Features== | ==Clinical Features== | ||
*Toxicity typically presents as cognitive issues | *Toxicity typically presents as cognitive issues | ||
| Line 16: | Line 17: | ||
**Acute | **Acute | ||
***“Manganese madness” | ***“Manganese madness” | ||
***Visual hallucinations | ***Visual [[hallucinations]] | ||
***Behavioral changes | ***Behavioral changes | ||
***Anxiety | ***[[Anxiety]] | ||
***Impotence | ***Impotence | ||
**Late | **Late manifestations | ||
***Tremor | ***[[Tremor]] | ||
***Impaired speech | ***[[dysarthria|Impaired speech]] | ||
***Loss of facial expressions | ***Loss of facial expressions | ||
***Gait disturbances | ***[[ataxia|Gait disturbances]] | ||
***Low volume speech | ***Low volume speech | ||
***Can mimic | ***Can mimic [[Parkinson’s disease]] | ||
*Pulmonary | *Pulmonary | ||
**Acute / Metal | **Acute / [[Metal fume fever]] | ||
***Fever | ***[[Fever]] | ||
***Nausea | ***[[Nausea]] | ||
***Headache | ***[[Headache]] | ||
*** | ***[[Myalgia]] | ||
*** | ***[[Arthralgia]] | ||
**Chronic | **Chronic | ||
***Persistent dry cough | ***Persistent dry [[cough]] | ||
***Bronchitis | ***[[Bronchitis]] | ||
***Chemical pneumonitis | ***Chemical [[pneumonitis]] | ||
*GI | *GI | ||
**Anorexia | **Anorexia | ||
*Musculoskeletal | *Musculoskeletal | ||
** | **[[Arthralgia]] | ||
**Muscle rigidity | **Muscle rigidity | ||
*Constitutional | *Constitutional | ||
**Lethargy | **[[Lethargy]] | ||
**Asthenia | **[[Weakness|Asthenia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Heavy metals list}} | |||
==Evaluation== | ==Evaluation== | ||
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**No definite toxic level | **No definite toxic level | ||
**Elevated levels are typically seen in acute toxicity, as manganese is quickly cleared from the blood | **Elevated levels are typically seen in acute toxicity, as manganese is quickly cleared from the blood | ||
*MRI | *[[brain MRI|MRI]] | ||
**Will show abnormal T1- weighted signal | **Will show abnormal T1- weighted signal hyperintensity in the basal ganglia, particularly in the globus pallidus, with normal T2-weighted images | ||
==Management== | ==Management== | ||
*Supportive care | *Supportive care | ||
*Remove source of exposure | *Remove source of exposure | ||
*Chelation therapy with CaNa<sub>2</sub>EDTA or DTPA | *Chelation therapy with CaNa<sub>2</sub>[[EDTA]] or DTPA | ||
**Can improve urinary excretion of manganese without affecting the neurologic manifestations | **Can improve urinary excretion of manganese without affecting the neurologic manifestations | ||
==Disposition== | ==Disposition== | ||
*Will depend on severity, most cases are likely seen in patients receiving TPN, and will likely need changes to their TPN orders and a consultation from nutrition | *Will depend on severity, most cases are likely seen in patients receiving TPN, and will likely need changes to their TPN orders and a consultation from nutrition | ||
*Consult Toxicology or | *Consult Toxicology or [[poison control]] | ||
==References== | ==References== | ||
Revision as of 22:51, 2 October 2019
Background
- An essential element in the diet
- Used in various enzymatic processes
- Mn2+ can take the place of Mg2+, Ca2+, and Fe2+ in various proteins and enzymes, and has been seen to replace Fe2+ in Hgb
- Low enteral absorption
- Cleared by the liver and excreted in the bile
- Typical routes of exposure
- Inhalation of dusts/fumes
- Seen in industrial areas as manganese is used to make steel
- Parenteral nutrition (TPN)
- IV Methcathinone
- Inhalation of dusts/fumes
- Readily crosses the blood brain barrier and can be seen concentrated in the basal ganglia, particularly the globus pallidus
Clinical Features
- Toxicity typically presents as cognitive issues
- Neuropsychiatric
- Acute
- “Manganese madness”
- Visual hallucinations
- Behavioral changes
- Anxiety
- Impotence
- Late manifestations
- Tremor
- Impaired speech
- Loss of facial expressions
- Gait disturbances
- Low volume speech
- Can mimic Parkinson’s disease
- Acute
- Pulmonary
- Acute / Metal fume fever
- Chronic
- Persistent dry cough
- Bronchitis
- Chemical pneumonitis
- GI
- Anorexia
- Musculoskeletal
- Arthralgia
- Muscle rigidity
- Constitutional
Differential Diagnosis
Heavy metal toxicity
- Aluminum toxicity
- Antimony toxicity
- Arsenic toxicity
- Barium toxicity
- Bismuth toxicity
- Cadmium toxicity
- Chromium toxicity
- Cobalt toxicity
- Copper toxicity
- Gold toxicity
- Iron toxicity
- Lead toxicity
- Lithium toxicity
- Manganese toxicity
- Mercury toxicity
- Nickel toxicity
- Phosphorus toxicity
- Platinum toxicity
- Selenium toxicity
- Silver toxicity
- Thallium toxicity
- Tin toxicity
- Zinc toxicity
Evaluation
- Lab
- Whole blood 4-15 μg/L (73-273 nmol/L)
- Serum 0.9-2.9 μg/L (16-52 nmol/L)
- Urine (24h) <10 μg/L (182 nmol/L)
- No definite toxic level
- Elevated levels are typically seen in acute toxicity, as manganese is quickly cleared from the blood
- MRI
- Will show abnormal T1- weighted signal hyperintensity in the basal ganglia, particularly in the globus pallidus, with normal T2-weighted images
Management
- Supportive care
- Remove source of exposure
- Chelation therapy with CaNa2EDTA or DTPA
- Can improve urinary excretion of manganese without affecting the neurologic manifestations
Disposition
- Will depend on severity, most cases are likely seen in patients receiving TPN, and will likely need changes to their TPN orders and a consultation from nutrition
- Consult Toxicology or poison control
References
Soghoian, S. Manganese. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1294-1298