What action should be taken regarding manganese dosing in PN if cholestasis is present?

• A. Increase Mn in PN to correct deficiency
• B. Decrease Mn in PN if cholestasis is present
• C. Switch to PN without any trace elements
• D. Monitor daily serum Mn and ignore results

Answer: (B)

When cholestasis is present, the body's ability to eliminate manganese through bile is impaired, so Mn can accumulate in the liver and brain and potentially cause neurotoxicity and hepatic issues. Because of this impaired excretion, the manganese dose in parenteral nutrition should be reduced to limit accumulation while still maintaining essential trace element needs. As cholestasis improves, the Mn dose can be reassessed and adjusted back toward normal levels. Monitoring Mn levels and clinical signs guides the management, rather than ignoring results; options that raise Mn or remove trace elements entirely risk deficiency or excessive toxicity, so the safer, evidence-based approach is to decrease Mn dosing during cholestasis.