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The whole blood manganese concentration was significantly increased after 2\u00bd months of parenteral nutrition (PN). Three months into his stay, he developed a resting tremor and extra-pyramidal dyskinesia. In the absence of other neurological symptoms, and with no history of essential tremor, Parkinsonism or cerebral signs, hypermanganesaemia was presumed to be the cause. We review manganese metabolism and toxicity in patients who are fed with parenteral nutrition and review the current recommendations and guidelines.<\/jats:p>","DOI":"10.1177\/1751143715622216","type":"journal-article","created":{"date-parts":[[2015,12,10]],"date-time":"2015-12-10T22:08:16Z","timestamp":1449785296000},"page":"252-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Manganese toxicity in critical care: Case report, literature review and recommendations for practice"],"prefix":"10.1177","volume":"17","author":[{"given":"Edward","family":"Walter","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Royal Surrey County Hospital, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"Alsaffar","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Royal Surrey County Hospital, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Callum","family":"Livingstone","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Royal Surrey County Hospital, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah L","family":"Ashley","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Royal Surrey County Hospital, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,6,23]]},"reference":[{"key":"bibr1-1751143715622216","doi-asserted-by":"publisher","DOI":"10.4067\/S0716-97602006000100006"},{"key":"bibr2-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/70.1.37"},{"key":"bibr3-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/60.6.949"},{"key":"bibr4-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuro.2012.10.018"},{"key":"bibr5-1751143715622216","first-page":"2863","volume-title":"Encyclopedia of food science, food technology, and nutrition","author":"Keen CL","year":"1993"},{"key":"bibr6-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/54.2.295"},{"key":"bibr7-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1002\/nbm.931"},{"key":"bibr8-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1007\/s12017-009-8101-2"},{"key":"bibr9-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-8993(98)00481-8"},{"key":"bibr10-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.8030"},{"key":"bibr11-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.9504"},{"key":"bibr12-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.10316"},{"key":"bibr13-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2006.09.002"},{"key":"bibr14-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/j.etap.2004.12.053"},{"key":"bibr15-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410360611"},{"key":"bibr16-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100038786"},{"key":"bibr17-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/kfg112"},{"key":"bibr18-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)92164-8"},{"key":"bibr19-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcp152"},{"key":"bibr20-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.3.698"},{"key":"bibr21-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.11.1.117"},{"key":"bibr22-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuro.2005.10.006"},{"key":"bibr23-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.08.011"},{"key":"bibr24-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1054\/clnu.2000.0120"},{"key":"bibr25-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-201X.1997.d01-841.x"},{"key":"bibr26-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1039\/c2tx20064c"},{"key":"bibr27-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1177\/0884533612446706"},{"key":"bibr28-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/75.1.112"},{"key":"bibr29-1751143715622216","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2009.04.024"},{"key":"bibr30-1751143715622216","unstructured":"Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. 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