Abstract | CONTEXT: CASE DETAILS: A 52-year-old woman was inadvertently administered a single intravenous dose of 800 mg compounded manganese chloride at an outpatient chelation center. In an attempt to minimize central nervous system (CNS) manganese deposition, she underwent urgent hemodialysis followed by five days of therapy with calcium disodium EDTA (1 g/m(2) over eight hours daily). Her initial whole blood manganese concentration, obtained six hours after exposure and prior to treatment, was 120 mcg/L (2.19 micromol/L); normal <5 mcg/L (< 0.09 micromol/L). Following the first four-hour hemodialysis session her blood manganese concentration decreased to 20 mcg/L (0.36 micromol/L). Despite the fall in her blood manganese concentration, analysis of dialysate revealed a total elimination of only 604 mcg (11 micromol) manganese (∼1.4% of manganese burden). Although she remained asymptomatic, an MRI on hospital day two revealed T1 hyperintensities within the bilateral globus pallidi, consistent with manganese exposure. DISCUSSION:
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Authors | Elizabeth Quaal Hines, Irfana Soomro, Mary Ann Howland, Robert S Hoffman, Silas W Smith |
Journal | Clinical toxicology (Philadelphia, Pa.)
(Clin Toxicol (Phila))
Vol. 54
Issue 6
Pg. 523-5
(Jul 2016)
ISSN: 1556-9519 [Electronic] England |
PMID | 27163837
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Chelating Agents
- Manganese
- Edetic Acid
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Topics |
- Administration, Intravenous
- Chelating Agents
(therapeutic use)
- Dose-Response Relationship, Drug
- Drug Overdose
(blood, therapy)
- Edetic Acid
(therapeutic use)
- Female
- Humans
- Magnetic Resonance Imaging
- Manganese
(administration & dosage, blood)
- Manganese Poisoning
(blood, therapy)
- Middle Aged
- Neurotoxicity Syndromes
(etiology, therapy)
- Renal Dialysis
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