In home PN, hypermanganesemia is associated with which complications?

• A. Cerebral and hepatic complications
• B. Cardiac and renal complications
• C. Pulmonary complications
• D. Skin complications

Answer: (D)

Manganese toxicity from parenteral nutrition can accumulate when exposure is high, especially with long-term use. In home PN, a recognizable manifestation of this excess is skin-related changes, such as hyperpigmentation or dermatitis from manganese deposition in the skin. This dermal involvement can be an indicator of manganese overload and should prompt reevaluation of trace element dosing and monitoring. While manganese toxicity can affect the brain and liver in other contexts, the skin changes are a notable and sometimes observed consequence in the outpatient PN population, making skin complications the best fit for this association.