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ACUTE EXPOSURE INFORMATION
- USES: Manganese is found in rock, soil, water, and food. Metallic manganese is used to harden and prevent corrosion and rusting of steel. It is also used in black paints and to decolorize glass. Manganese dioxide is used in dry cell batteries as a depolarizer. Potassium permanganate is covered in a separate management.
- PHARMACOLOGY: Manganese is an essential nutrient and is a cofactor for many biologic enzyme systems.
- TOXICOLOGY: Manganese deposition throughout the brain may lead to neurotoxicity. Manganese primarily deposits in the basal ganglia. Severe toxicity is characterized by a Parkinson's-like syndrome.
- EPIDEMIOLOGY: Toxicity from acute ingestion or acute inhalation of manganese is rare. Chronic inhalation over many years, usually from occupational exposure, may lead to manganese toxicity. Chronic manganese toxicity is exceedingly rare in the developed world due to workplace regulations. Manganese toxicity has been rarely reported in individuals injecting methcathinone that has been synthesized by combining pseudoephedrine and potassium permanganate.
- WITH POISONING/EXPOSURE
- OVERDOSE: Little data is available regarding clinical effects in overdose. Most toxicity is due to chronic workplace exposure.
- MILD TO MODERATE TOXICITY: Neurotoxicity is the primary manifestation of manganese toxicity. Patients may develop headaches, dizziness, memory loss, emotional instability, hyperreflexia, and a mild tremor. Chronic excess inhalational exposures may lead to pulmonary inflammation and subsequent reactive airway disease. Metal fume fever has been reported with manganese inhalation. Manganese is poorly absorbed dermally and systemic toxicity from this route is not expected. Dermal exposures may lead to a dermal irritation and contact dermatitis.
- SEVERE TOXICITY: Manganese may lead to neurotoxicity that resembles Parkinson disease. These patients may have bradykinesia, resting tremor, psychiatric disturbances, and shuffling gait. Manganese neurotoxicity has been shown to progress 10 years after cessation of exposure. "Manganese madness" is characterized by compulsiveness, anxiety, and aggressiveness.
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