Manganese injection typically refers to the administration of manganese as a medication or supplement via intravenous (IV) route. Manganese is an essential trace mineral that plays various roles in the body, including metabolism, bone formation, and antioxidant function. However, manganese injections are not commonly used in clinical practice and are typically reserved for specific medical conditions where oral supplementation is not feasible or effective.

Manganese Injection is used as a supplement added to parenteral nutrition to replace the daily requirements in patients who can not tolerate orally or whose diet is deficient in manganese. Manganese is usually required for bone growth, proper functioning of enzymes, and neuronal transmission in the brain. It is normally stored in the liver, kidneys, pancreas, and bones.

Manganese Injection Uses:

• It is a trace element that is added to parenteral nutrition to prevent manganese deficiency.
• It may be used orally as a dietary supplement in individuals who are deficient, those with malabsorption, and poor diets.

Manganese Injection Dose in Adults:

Manganese Injection Dose as maintenance requirement in the Parenteral nutrition:

• When using manganese injections to keep up with the body's needs during parenteral nutrition (feeding through a vein), experts suggest giving between 150 to 800 micrograms (mcg) of manganese each day.
• However, it's better to lean towards the lower end, around 60 to 100 mcg daily, to prevent nerve problems, especially for people with liver issues causing jaundice.
• But, it can be hard to stick to these lower doses because the manganese solutions available for injection often don't match these recommendations.

Manganese Injection Dose in Childrens:

Manganese Injection Dose as maintenance requirement in the Parenteral nutrition:

• When using manganese injections as part of parenteral nutrition, the typical dose ranges from 2 to 10 micrograms per kilogram of body weight each day when given intravenously.
• However, experts advise lowering this dose for infants and children to around 1 microgram per kilogram per day, with a maximum of 50 micrograms per day.
• But, it's tricky to stick to these guidelines because the manganese solutions available for injection often don't match these recommendations, according to ASPEN (American Society for Parenteral and Enteral Nutrition) guidelines from Vanek in 2012.

It's important to be careful when using manganese injections in premature newborns because the manganese chloride solution used for injection contains aluminum, which may pose risks.

Pregnancy Risk Factor C

• During pregnancy, manganese is categorized as having a risk factor C, meaning there's not enough evidence from animal studies to determine its effects on pregnancy.
• However, manganese can pass through the placenta and be found in both placental tissue and cord blood, as noted in a study by Osada in 2002.

Manganese use during breastfeeding:

• Manganese is present in breast milk, although in lower concentrations compared to cow's milk or other food sources.
• However, despite the lower concentration, manganese from human milk is absorbed by the baby's body more efficiently, according to the Institute of Medicine in 2004.

Dose in Kidney Disease:

• In cases of kidney impairment, it's important to use manganese injections cautiously because the manganese chloride solution used for injection contains aluminum.
• Aluminum can potentially cause harm to the kidneys, so it's essential to be cautious when administering manganese injections to individuals with renal issues.

Dose in Liver disease:

• For individuals with liver impairment, it's crucial to exercise caution when using manganese injections.
• In such cases, the dosage might need adjustment or even withholding, especially if there are elevated bilirubin levels or confirmed cholestatic disease.
• This precaution is important to avoid potential complications and ensure the safety of the patient.

Side effects of Manganese Injection:

Most side effects as a result of toxicity or overdosage include:

• Tremors
• Facial spasms
• ataxia
• Loss of balance
• Parkinson-like effects
• Aggression
• Hallucinations
• Abnormal behaviors
• Irritability

The psychiatric manifestations as a result of chronic overdosage have been labeled as Manganesim.

Contraindications to Manganese Injection:

The manufacturer's US labeling does not list any specific contraindications for manganese injections.

However, caution should still be exercised, especially in individuals with renal or hepatic impairment, as mentioned earlier.

Warnings and precautions

Insufficiency of the biliary tract:

• Use with caution in patients with biliary tract impairment.
• The dose may need to be decreased or withheld depending on the severity of the impairment.

Renal impairment

• Use with caution in patients with hepatic impairment.
• The dose may need to be decreased or withheld, especially if there are elevated bilirubin levels or confirmed cholestatic disease.

Monitoring parameters:

Periodic Manganese Plasma Level Monitoring:

• Regular monitoring of manganese levels in the blood.
• Helps in ensuring that manganese levels remain within the safe range.
• Especially important in patients receiving long-term manganese supplementation or those at risk of toxicity.
• Allows for adjustments in dosage if needed to prevent potential adverse effects.

How to administer Manganese?

Capsule, Tablet Administration:

• May be taken with a meal for better absorption.

Solution for Injection:

• Avoid intramuscular (IM) or direct intravenous (IV) injection.
• The solution has an acidic pH, which may cause tissue irritation.
• It is hypotonic, meaning it has lower osmotic pressure compared to body fluids.
• Administer after dilution in a volume of fluid equal to or greater than 100 mL to reduce irritation and ensure safety.

Mechanism of action of Manganese:

• Acts as a cofactor in numerous enzyme systems within the body.
• Stimulates the synthesis of cholesterol and fatty acids in the liver.
• Plays a role in influencing the synthesis of mucopolysaccharides, which are important components of connective tissues.

Absorption:

• Manganese absorption is generally poor in the body.

Distribution:

• Manganese tends to accumulate in the mitochondria of various organs including the pituitary gland, pancreas, liver, kidney, and bone.

Excretion:

• Primarily excreted through bile.
• Minimal excretion occurs through urine.

International Brand Names of Manganese Injection:

• Mangimin
• MN-50
• Micro-Mn

Manganese Inejction Brand Names in Pakistan:

No Brands Available in Pakistan