Abstract
Mn, like copper, is an essential trace element that is excreted almost entirely via the bilary tract. Copper accumulation occurs when bile flow is compromised but similar data for Mn are not available. The objective of this study was to determine serum Mn concentrations in a patient with cholestatic liver disease who was receiving TPN. The subject was a 16 month old female, weighing 10.5 kg, with intractable diarrhea who had been receiving TPN since 1 week of age. Despite repeated attempts at partial enteral feeding, she developed progressive cholestatic liver disease. At the time of this study, liver function tests included: bilirubin 10.4 mg/dl, AST 424 IU/l, alk phos 264 IU/l. She had been receiving 2.4 mcgMn/day added to her TPN infusate. The table gives serum Mn levels determined by flameless atomic absorption spectrophotometry before and at progressive intervals after Mn was withheld from the infusate:
Two additional patients, aged 9 and 15 months, who had also been receiving Mn in long-term TPN but had not developed significant cholestasis both had serum Mn of 1.0 ng/ml. It is suggested that intravenous Mn, as a component of TPN, be administered in reduced quantities to children with cholestatic liver disease.
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Hambidge, K., Casey, C., Sokol, R. et al. ELEVATED SERUM MANGANESE (Mn) IN TOTAL PARENTERAL NUTRITION (TPN) CHOLESTATIC LIVER DISEASE. Pediatr Res 21 (Suppl 4), 269 (1987). https://doi.org/10.1203/00006450-198704010-00611
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DOI: https://doi.org/10.1203/00006450-198704010-00611