How should manganese be adjusted in PN patients with hepatobiliary disease such as cholestasis?

• A. Increase Mn
• B. No change
• C. Switch to parenteral nutrition only
• D. Reductions in Mn should be considered. Supplemental Mn may need to be removed from PN in long-term PN patients

Answer: (D)

Manganese is handled by the liver and is mainly excreted in bile. In hepatobiliary disease such as cholestasis, biliary excretion is impaired, so Mn can accumulate in the body and potentially cause neurotoxic effects, especially with long-term PN.

Therefore, the best approach is to reduce manganese in the PN regimen, and in patients on long-term PN, supplemental Mn may need to be removed entirely to prevent accumulation. This targeted adjustment addresses the underlying excretion issue and minimizes toxicity risk.

Increasing Mn or leaving it unchanged would worsen the accumulation risk, and switching to PN alone doesn’t address the Mn handling problem.