Medical Analysis

Introduction: Understanding Manganese as a Vital Trace Element

Manganese is a trace element. It is obtained from dietary sources, as well as occupational and environmental sources [5, 10]. The test measures bivalent manganese in its dissolved form. The manganese concentration can be measured semiquantitatively by visual comparison of the color of the measurement solution with the color fields of the color disk [15]. It may be corrosive to metals, and it also causes severe skin burns and damage to eyes [15]. Manganese deficiency in humans is rare [5, 10].

Manganese Pathophysiology: Neurotoxicity and Systemic Effects

Manganese (Mn) is a well-established neurotoxin associated with specific damage to the basal ganglia in humans [3, 12]. Excessive exposure or intake may lead to a condition known as manganism, a neurodegenerative disorder that causes dopaminergic neuronal death and parkinsonian-like symptoms [7, 12]. Continued exposure can damage the lungs, liver, and kidneys [4, 15].

Manganese Functions and Clinical Utility

Manganese (Mn) testing is used to evaluate central nervous system symptoms similar to Parkinson disease in workers handling Mn compounds in mining and industry, and also for characterization of liver cirrhosis [7, 14]. It can also be used in the evaluation of Behcet disease [14]. Manganese deficiency in humans is rare [5].

Dietary Sources of Manganese

Manganese is found in a variety of foods [5]. Key sources include:

• Shellfish: mussels, oysters, clams [5].

• Nuts: especially hazelnuts and pecans [5].

• Grains/Cereals: brown rice and oatmeal [5].

• Legumes: soybeans, kidney beans, chickpeas, lentils, peanuts [5].

• Beverages/Spices: black tea and black pepper [5].

• Produce: spinach and pineapple [5].

Daily Dietary Intake for Manganese

(Source: Reference 5)

Manganese Test Indications

Medical professionals order this test for several key reasons [2, 10]:

• To evaluate central nervous system symptoms similar to Parkinson disease [7].

• For workers handling Mn compounds in mining and industry [14].

• For characterization of liver cirrhosis [14].

• In the evaluation of Behcet disease [14].

• To detect and monitor exposure to manganese with suspicion of toxicity [4].

• To evaluate the effectiveness of treatment in people diagnosed with manganese poisoning [14].

• To monitor potential accumulation with TPN (Total Parenteral Nutrition) [10].

Sample Collection for Manganese Testing

Testing can be performed on various samples to determine exposure levels [2, 10].

Instructions Prior to Sample Collection

For both blood and urine samples, consider the following [10]:

• Discontinue nutritional supplements, vitamins, minerals, and non-essential over-the-counter medications [10].

• High concentrations of iodine may interfere with elemental testing; if a concerning history exists, do not collect the sample for at least 72 hours [10].

• Collection from patients with impaired kidney function should be avoided for a minimum of 14 days post-contrast media exposure [10].

Laboratory Methods

Detection is primarily performed via:

• Inductively coupled plasma mass spectrophotometry (ICP-MS) [2, 10].

• Atomic absorption spectrophotometry (AAS) [10].

Sample Collection Protocol

• Collect 3.0 ml blood in a plain tube (Red capped) or Sodium Heparin (Green capped) [10].

• Separate serum or plasma as early as possible and send to the lab in a frozen state [10].

• Collect 10 ml urine or 24-hour urine specimen without acid as a preservative in a clear sterile container [10].

• Note: Specimens collected in lithium heparin or sodium fluoride/potassium oxalate and grossly haemolyzed specimens are not suitable for testing [10].

Urinary Manganese Analysis

Excretion of excess Mn from the body occurs through urine [15]. Occupational exposure or excessive nutritional intake may show higher levels, whereas specimens from normal people have negligible levels [2, 14].

Urine Reference Ranges

• Manganese, Urine – per volume: 0.0-5.0 µg/L [10].

• Manganese, Urine – per 24h: 0.0-5.0 µg/d [10].

• Manganese, Urine – ratio to CRT: 0.0-5.0 µg/g CRT [10].

Urine Manganese Reference Range (mgs/day)

(Source: Reference 10)

Serum Manganese Reference Ranges

The reference range for serum manganese is 7 to 12 µg/L [10].

Causes of Abnormal Plasma Manganese

Raised Plasma Manganese:

• Acute or chronic kidney disease [2, 4].

• Proton pump inhibitors [10].

• Malnourishment [2].

• Alcoholism [2].

• Hypothyroidism and Cortico-adrenal insufficiency [2].

Lower Plasma Manganese:

• Too little intake of magnesium [5, 10].

• Excessive loss of magnesium through kidneys or gastrointestinal tract [10].

• Movement of magnesium from extracellular fluid into less accessible locations [2, 10].

Toxicity Symptoms

Exposure to excessive manganese may present with the following symptoms [2, 7, 12]:

• Tremors and muscle spasms.

• Decreased hand-eye coordination.

• Decreased balance.

• Hearing loss.

• Headaches.

• Depression and mood changes.

For Non-Medicos: Understanding Manganese Exposure

Manganese is a mineral your body needs in tiny amounts, usually obtained through a healthy diet [5]. While essential, too much of it can be harmful, acting as a toxin that particularly affects the brain, specifically areas that control movement [3, 11].

When is Testing Needed?

Doctors may test for manganese if you work in industries like mining, if you show symptoms similar to Parkinson’s disease (like tremors or balance issues), or if you are being treated for conditions like liver or Behcet disease [7, 14]. It is also monitored for patients receiving long-term intravenous nutrition [10].

What Do the Results Mean?

• High Levels: Could be caused by kidney issues, certain medications like stomach acid reducers, malnutrition, or heavy alcohol use [2, 10].

• Low Levels: Often related to not getting enough magnesium in your diet or losing it through your digestive system or kidneys [10].

Safety Tips for Testing

If you are scheduled for a test, talk to your doctor about stopping vitamins or supplements beforehand [10]. Avoid the test if you have recently had a medical procedure involving contrast dye (like certain X-rays or scans), as it can interfere with results [10]. Always follow your healthcare provider’s specific instructions for the most accurate diagnosis [10].

References:

1. Aschner, M., & Dorman, D. C. (2018). Manganese. In Handbook on the Toxicology of Metals.

2. Bjørklund, G., et al. (2017). Manganese: Toxicology and human health. Journal of Trace Elements in Medicine and Biology.

3. Bowyer, J. F., et al. (2019). Manganese neurotoxicity: A review of the state of the art. NeuroToxicology.

4. Crossgrove, J., & Zheng, W. (2004). Manganese toxicity upon overexposure. NMR in Biomedicine.

5. Food and Nutrition Board. (2001). Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academies Press.

6. Guilarte, T. R. (2013). Manganese neurotoxicity: New perspectives from magnetic resonance imaging. Toxicological Sciences.

7. Levy, B. S., & Nassetta, W. J. (2003). Neurologic effects of manganese in humans: A review. Environmental Health Perspectives.

8. Lucchini, R. G., et al. (2012). Manganese: A new look at an old metal. Journal of Trace Elements in Medicine and Biology.

9. Mayo Clinic. (2025). Manganese: Supplementation and Toxicity Risks.

10. National Institutes of Health. (2024). Manganese: Fact Sheet for Health Professionals.

11. O’Neal, S. L., & Zheng, W. (2015). Manganese toxicity upon overexposure: A decade in review. Current Environmental Health Reports.

12. Perl, D. P., & Olanow, C. W. (2007). The neuropathology of manganese-induced parkinsonism. Journal of Neuropathology & Experimental Neurology.

13. Roels, H. A., et al. (2012). Manganese exposure and health effects. International Journal of Hygiene and Environmental Health.

14. Smith, D., et al. (2017). Clinical evaluation of manganese poisoning in industrial settings. Occupational and Environmental Medicine.

15. World Health Organization. (2004). Manganese and its compounds: Environmental health criteria.

FAQ’s:

• What is manganese?
  A trace element essential for the human body, obtained primarily through diet.

• Is manganese toxicity common?
  It is rare but can occur from excessive exposure, leading to neurological damage and parkinsonian symptoms.

• What foods contain manganese?
  Shellfish, nuts, grains, legumes, spinach, pineapple, and black tea are excellent sources of manganese.

• Why test for manganese?
  To evaluate neurological symptoms, assess occupational exposure, or monitor liver cirrhosis and Behcet disease.

• Does manganese cause symptoms?
  Excessive exposure can cause tremors, muscle spasms, coordination issues, headaches, mood changes, and hearing loss.

• How is manganese tested?
  Testing is typically performed on blood, urine, hair, or nail samples using advanced laboratory methods.

• Are there test requirements?
  Yes, avoid vitamins or supplements beforehand and avoid testing shortly after procedures involving contrast dye.

• What are normal ranges?
  Serum manganese levels typically range from 7 to 12 µg/L in healthy individuals.

• What affects test results?
  Kidney disease, certain medications, malnutrition, alcohol use, and hypothyroidism can alter manganese test results.

• Where is it found?
  Manganese is found in various dietary sources and occupational or environmental settings like mining.