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Which of the following is true concerning manganese and patients on long-term parenteral nutrition (PN)? Manganese deficiency occurs in patients on PN for greater than 1 year Hypermanganesemia has been reported only in patients with cholestasis Manganese in commercial trace element preparations may result in hypermanganesemia The best indicator of manganese status is serum manganese CORRECT ANSWER Manganese in commercial trace element preparations may result in hypermanganesemia Hypermanganesemia has been reported in >50% of home PN patients accompanied by clinically significant cerebral and hepatic complications. Manganese (Mn) is almost exclusively excreted via the hepatobiliary system. Therefore, reductions in Mn dosing should be considered in patients with hepatobiliary disease such as cholestatic liver disease. Patients at risk for developing Mn toxicity include those receiving long-term PN (>30 days) who develop obstruction of the biliary duct and are unable to excrete Mn. Supplemental Mn may need to be removed from the PN solution in long-term PN patients. Brain deposition of Mn can occur with IV Mn administration of 1.1 mg/day. Magnetic resonance imaging (MRI) can detect Mn toxicity but the procedure is expensive. The best method of monitoring Mn status is with whole blood Mn levels as they correlate well with MRI abnormalities. Of the many online resources for HEN and HPN, which organization provides an annual summer conference and online education modules? A. Coping Well () B. Feeding Tube Awareness Foundation () C. Oley Foundation (ww