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Unit Code 8413:
Manganese, Serum

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Useful For

Monitoring manganese exposure

 

Nutritional monitoring

 

Clinical trials

Clinical Information

Manganese (Mn), atomic number 25, atomic weight 54,938049, is a

trace essential element with many industrial uses. The 12th most

abundant element in the earth's crust, nearly all mined manganese

is consumed in the production of ferromanganese, which is then

used to remove oxygen and sulfur impurities from steel. These

industrial processes cause elevated environmental exposures to

airborne manganese dust and fumes, which in turn have lead to

well-documented cases of  neurotoxicity among exposed workers.

Mining and iron and steel production have been implicated as

sources of exposure.

 

Inhalation is the primary source of entry for manganese toxicity.

Signs of toxicity may appear quickly or not at all; neurological

symptoms are rarely reversible. Manganese toxicity is generally

recognized to progress through 3 stages. Levy describes these

stages. "The first stage is a prodrome of malaise, somnolence, apathy,

emotional lability, sexual dysfunction, weakness, lethargy, anorexia,

and headaches. If there is continued exposure, progression to a

second stage may occur, with psychological disturbances, including

impaired memory and judgement, anxiety, and sometimes psychotic

manifestations such as hallucinations. The third stage consists of

progressive bradkinesia, dysarthrian axial and extremity dystonia,

paresis, gait disturbances, cogwheel rigidity, intention tremor,

impaired coordination, and a mask-like face. Many of those affected

may be permanently and completely disabled."(1)

 

Few cases of manganese deficiency or toxicity due to ingestion have

been documented. Only 1%-3% manganese is absorbed via ingestion,

while most of the remaining manganese is excreted in the feces. As

listed in the United States National Agriculture Library, manganese

adequate intake is 1.6-2.3 mg/day for adults. This level of intake is

easily achieved without supplementation by a diverse diet including

fruits and vegetables, which have higher amounts of manganese than

other food types. Patients on a long-term parenteral nutrition should

receive manganese supplementation and should be monitored to

ensure that circulatory levels of manganese are appropriate.

Reference Values

Lowest reportable: <0.1 ng/mL

Normal range: 0.40-0.85 ng/mL

Interpretation

Serum manganese results elevated above the alert value

indicated recent exposure.

Cautions

Normal specimens have extremely low levels of Mn; therefore,

elevated results could easily be a result of external contamination.

Precautions must be taken to ensure the specimen is not

contaminated. Metal-free serum collection procedures must

be followed and centrifuged serum must be aliquoted into an

acid-washed Mayo metal-free vial. Specimens collected using

an anticoagulant are unacceptable, due to trace amounts of

manganese found in anticoagulants.

 

High concentrations of gadolinium and iodide are known to interfere

with most metals tests. If either gadolinium or iodide-containing

contrast media has been administered a specimen can not be

collected for 48 hours.

Special Instructions and Forms

• Metals Analysis - Collection and Transport 

Clinical Reference

1.   Levy BS, Nassetta WJ:  Neurologic effects of Manganese in

      humans: A review. Int J Occup Environ Health Apr/Jun 2003;

      9(2):153-163

 

2.   Chiswell B, Johnson D:  Manganese. In Handbook on Metals in

      Clinical and Analytical Chemistry. Edited by HG Sigel, H Sigel.

      Marcel Dekker, Inc, New York, 1994, pp 479-494 

 

3.   Finley J, Davis C:  Manganese deficiency and toxicity: Are high

      or low dietary amounts of manganese cause for concern?

      Biofactors 1999;10:15-24

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