Manganese Poisoning Induced by Total Parenteral Nutrition in the ICU: A Case Report and Review

Introduction: Manganese is an essential trace element for humans. It has been recognized as a potential occupational toxic but its danger as toxic in patients under parenteral nutrition is often forgotten. Case report: 73-year-old man, logged 210 days in Intensive Care Unit (ICU), receiving total parenteral nutrition (TPN) for a month, current disease chorea-type movements in the head and neck and left hemi body. Diagnostic tests: Magnetic resonance image findings suggest manganese deposit, total blood manganese concentration (34 µg. L-1) (reference range: less than 13 µg. L-1). Diagnosis: Abnormal movements can be caused by manganese poisoning due to parenteral nutrition and are associated with liver failure in the ICU. Discussion and Conclusions: After a prolonged stay in ICU, assessing liver failure caused by septic and protracted parenteral nutrition, manganese poisoning should be considered as a cause of chorea-type movements.