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Manganese (Mn) is a trace essential element with many industrial uses. Inhalation is the primary source of entry for Mn, but is also partially absorbed (3%-5%) through the gastrointestinal tract. Only very small amounts of Mn are absorbed dermally. Signs of toxicity may appear quickly, and neurological symptoms are rarely reversible. Mn toxicity is generally recognized to progress through 3 stages. Levy describes these stages. The first stage is a prodrome of malaise, somnolence, apathy, emotional lability, sexual dysfunction, weakness, lethargy, anorexia, and headaches. If there is continued exposure, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgement, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthrian axial and extremity dystonia, paresis, gait disturbances, cogwheel rigidity, intention tremor, impaired coordination, and a mask-like face. Many of those affected may be permanently and completely disabled.(1) Mn is removed from the blood by the liver where its conjugated with bile and excreted. Ref. value: 0-17 years: Not established > or =18 years: 0.5-1.2 ng/mL
One week before specimen collection, avoid vitamin, mineral, and herbal supplements. When administering contrast media containing gadolinium or iodine, a specimen shouldn't be collected for 96 hours.