Manganese Injection - as a Supplement for Parenteral Nutrition

Manganese Injection is used as a supplement added to parenteral nutrition to replace the daily requirements in patients who can not tolerate orally or whose diet is deficient in manganese. Manganese is usually required for bone growth, proper functioning of enzymes, and neuronal transmission in the brain. It is normally stored in the liver, kidneys, pancreas, and bones.

Manganese Injection Uses:

It is a trace element that is added to parenteral nutrition to prevent manganese deficiency.
It may be used orally as a dietary supplement in individuals who are deficient, those with malabsorption, and poor diets.

Manganese Injection Dose in Adults:

Manganese Injection Dose as maintenance requirement in the Parenteral nutrition:

150 to 800 mcg/day intravenously.
Most experts recommend a lower dose of 60 to 100 mcg/day to avoid neurotoxicity and cholestatic jaundice.
Administering lower doses with the current formulations is difficult and may be administered by reducing its frequency (if the dose can not be reduced).

Manganese Injection Dose in Childrens:

Manganese Injection Dose as maintenance requirement in the Parenteral nutrition:

2 to 10 mcg/kg/day intravenously.
Most experts recommend lower daily doses of 1 mcg/kg/day (up to a maximum of 50 mcg/day) in infants and children.
It may be difficult to administer such a low dose with the currently available formulations, however, one approach is to reduce the frequency of the drug administration.

Note: It should be used with caution in premature neonates as the formulation may contain aluminum that may result in aluminum toxicity.

Pregnancy Risk Factor C

It has not yet been tested in animals or humans. Manganese crosses the placental barrier, and can be detected in fetal circulation.

Manganese use during breastfeeding:

Human breastmilk contains manganese.
Manganese levels in human milk are higher than in cow's milk. However, human breastmilk absorbs manganese better.

Dose in Kidney Disease:

The formulation contains aluminum and should be used with caution in patients with kidney disease.

Dose in Liver disease:

It should be used with caution in patients with liver disease and particularly in patients with the cholestatic disease or raised bilirubin levels.

Side effects of Manganese Injection:

Most side effects as a result of toxicity or overdosage include:

Tremors
Facial spasms
ataxia
Loss of balance
Parkinson-like effects
Aggression
Hallucinations
Abnormal behaviors
Irritability

The psychiatric manifestations as a result of chronic overdosage have been labeled as Manganesim.

Contraindications to Manganese Injection:

The US labeling does not contain any contraindications.

Warnings and precautions

Insufficiency of the biliary tract:
- Patients suffering from liver disease, particularly biliary tract diseases, should not be given treatment and should reduce dosage.
Renal impairment
- Aluminum toxicity can occur in patients with kidney disease, especially those on hemodialysis. It is important to withhold or avoid the treatment.

Monitoring parameters:

Monitoring manganese plasma levels periodically. Monitor for drug toxicity and bone growth in children.

How to administer Manganese?

Capsule, tablet:

The capsule may be administered with a meal.

Solution for injection:

The injection should be slowly infused (added to parenteral nutrition). Intramuscular administration or direct intravenous administration should be avoided.
Since the formulation is acidic and hypotonic, it may cause local tissue irritation and necrosis. The injection should be diluted in a 100 ml fluid or more.

Mechanism of action of Manganese:

It is an essential cofactor in many enzymes that are necessary for body function, including neuronal functions.
It is a cofactor in many enzyme systems that are required for body functioning, including the synthesis cholesterol and fatty acid in the liver.

Absorption: