Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences
Manager
Telephone: 412-864-4151

Patients and medical professionals may call 1-800-533-UPMC (8762) for more information.
 

Patients and medical professionals may call 1-800-533-UPMC (8762) for more information.
 

UPMC Media Relations 

Changes in Standard Intravenous Formula Can Reverse Neurological Problems Seen in Patients Needing Intestine Transplants, Concludes University of Pittsburgh Study

MIAMI, September 11, 2003 - Intravenous feedings may do well to provide patients with small bowel failure their required daily nutrition, but its long-term use can cause their liver to fail and Parkinsons-like neurological symptoms, particularly in those patients who do develop liver problems. While the components of total parenteral nutrition (TPN) that contribute to liver failure remain a mystery, the tiniest amount of manganese typically added to TPN is responsible for the same kind of toxic effects on patients with liver failure as have been seen in miners with prolonged exposure to ore, in whom manganese poisoning was first described.

Removing manganese from TPN formulas can reverse these neurological deficits, Karen Laughlin, PharmD, of the University of Pittsburgh Medical Centers Thomas E. Starzl Transplantation Institute, will report at the VIII International Small Bowel Transplant Symposium being held Sept. 11 13 at the Sheraton Bal Harbour in Miami Beach, Fla.

Every patient being evaluated for intestinal transplantation should have routine tests to determine the level of manganese in their blood. We have found it essential to perform these profiles and we adjust the TPN accordingly, said Dr. Laughlin, assistant professor in the department of pharmacy and therapeutics, University of Pittsburgh School of Pharmacy, and clinical pharmacist with the Starzl Transplantation Institutes Center for Intestinal Rehabilitation and Transplantation.

High manganese levels present a bigger problem than one would think, she added.

Of 59 TPN-dependent patients who were evaluated for intestine, liver/intestine or multivisceral transplantation at the University of Pittsburgh, 46 patients, or 78 percent, had elevated levels of manganese. Most of these patients 34 of the 46 had significant complications involving their liver. In contrast, only two of 13 patients with normal manganese levels had any liver problems, which also were milder in comparison.

Manganese is an essential trace element necessary for good nutrition and contained in unrefined cereals and green leafy vegetables. As such, it is a staple ingredient in most TPN formulas.

I would surmise that most pharmacists and providers of TPN are not aware of the possible development of manganese toxicity in patients with short gut syndrome who require long-term TPN therapy. Therefore, it is not surprising that many of our new patients who have been on a standard TPN formula containing manganese have, over time, developed a host of neurological symptoms, Dr. Laughlin said.

Symptoms of manganese poisoning include delayed thinking, difficulty concentrating, tremors and rigid or stiff movements of the arms and legs.

About 25 percent of adult patients and 45 percent of pediatric patients on long-term TPN develop liver failure, which can occur within a few months to several years from when therapy began. Most often, the TPN will cause blockages within the bile duct system of the liver, which as a result, make it difficult for manganese and other toxins to be adequately excreted. With successful intestinal transplantation and resumption of normal function of the intestine, the risk of manganese toxicity and other associated TPN problems are reversed or totally eliminated.

The University of Pittsburgh Medical Centers Thomas E. Starzl Transplantation Institute is considered a pioneering center for intestinal transplants. Surgeons there have performed 259 intestine transplants since May 1990 the largest experience of any center in the world and have developed many of the surgical techniques and medical management approaches that have made transplants of the intestine alone or in combination with the liver and other organs both feasible and increasingly more successful.

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com