What are the symptoms of a severe manganese deficiency?

Symptoms of Severe Manganese Deficiency

Severe manganese deficiency is extremely rare in humans but can cause a constellation of symptoms affecting multiple body systems including skin, bone metabolism, glucose regulation, and neurological function.

Clinical Manifestations of Manganese Deficiency

Dermatological Symptoms

• Transient skin rash 1
• Poor wound healing

Metabolic and Biochemical Abnormalities

• Decreased serum cholesterol concentrations 1
• Elevated alkaline phosphatase levels 1
• Elevated calcium and phosphorus blood concentrations 1
• Abnormal glucose tolerance 1
• Altered lipid metabolism 1
• Altered carbohydrate metabolism 1

Skeletal System Effects

• Poor bone formation 1
• Skeletal defects 1
• Impaired growth 1

Neurological and Psychiatric Symptoms

• Altered mood states 1, 2
• Increased pain sensitivity during menstrual cycle in women 1
• Potential association with Huntington's disease pathology 1
• Cognitive impairments

Reproductive Effects

• Low birth weight in infants born to mothers with low manganese levels 1
• Potential fertility issues

Diagnostic Considerations

Manganese deficiency can be assessed through:

• Whole blood or RBC manganese measurements 1
• Plasma manganese analysis using spectrophotometry, mass spectrometry, neutron activation analysis, or x-ray fluorimetry 1

Important Clinical Context

It's crucial to understand several key points about manganese deficiency:

1. Extreme rarity: Manganese deficiency is exceptionally rare in humans 1, 3 with only 2.1% of critically ill patients showing decreased values 1

2. Iron relationship: Iron deficiency can paradoxically increase manganese levels due to competition for similar transport proteins 1, 4

3. Toxicity concern: Manganese toxicity is a much greater clinical concern than deficiency 1, with neurological symptoms resembling Parkinson's disease (manganism) 3, 5, 6

4. Daily requirements: The adequate intake for adults is approximately 2 mg/day (2.3 mg for men and 1.8 mg for women) 1

5. Dietary sources: Manganese is available in whole grains, clams, oysters, mussels, nuts, soybeans, legumes, rice, leafy vegetables, coffee, tea, and many spices 1

Clinical Pitfalls to Avoid

• Don't confuse manganese deficiency symptoms with those of other trace element deficiencies (zinc, copper)
• Be aware that iron supplementation in manganese-deficient patients may be necessary to prevent excessive manganese absorption 1, 4
• Recognize that neurological symptoms are more likely to indicate manganese toxicity rather than deficiency 1, 3
• Remember that parenteral nutrition can lead to manganese toxicity rather than deficiency due to bypassing the gut's regulatory mechanisms 1