Manganese, 24 Hour, Urine

CPT CODE:

USEFUL FOR:

Monitoring manganese exposure
Nutritional monitoring
Clinical trials

SPECIMEN REQUIRED:

1. 10 mL from a 24-hour urine collection. No preservative. See    "Urine Preservatives" in Special Instructions for multiple    collections.2. Collect in a clean, plastic urine container(s) with no metal    cap(s) or glued insert(s).3. Send specimen in a plastic, 13-mL urine tube or a clean,     plastic aliquot container with no metal cap or glued insert.4. See "Metals Analysis - Collection and Transport" in Special    Instructions for complete instructions.5. Refrigerate specimen within 4 hours of completion of    24-hour collection. Send specimen refrigerated.Note:    1. High concentrations of gadolinium and iodide are                 known to interfere with most metals tests. If either                 gadolinium- or iodide-containing contrast media has                 been administered, a specimen cannot be collected                 for 48 hours.             2. 24-Hour volume is required on request form for                 processing.  Urine Preservative Collection OptionsNote:    The addition of preservative or application of temperature              controls must occur within 4 hours of completion of the              collection.
Ambient:                YesRefrigerate:           PreferredFrozen:                 Yes6N HCl:                 Yes50% Acetic Acid:   NoNa(2)CO(3):          NoToluene:                No6N HNO(3):           NoBoric Acid:            NoThymol:                 No

TRANSPORT TEMPERATURE:

Refrig\Frozen OK\Ambient OK

CLINICAL INFORMATION:

Manganese (Mn), atomic number 25, atomic weight 54,938049, is atrace essential element with many industrial uses. The 12th mostabundant element in the earth's crust, nearly all mined manganeseis consumed in the production of ferromanganese, which is then used to remove oxygen and sulfur impurities from steel. Theseindustrial processes cause elevated environmental exposures to airborne manganese dust and fumes, which in turn have lead to well-documented cases of  neurotoxicity among exposed workers. Mining and iron and steel production have been implicated as sources of exposure.
Inhalation is the primary source of entry for manganese toxicity. Signs of toxicity may appear quickly or not at all; neurological symptoms are rarely reversible. Manganese 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, progressionto 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 bradkinesia, 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)
Few cases of manganese deficiency or toxicity due to ingestion have been documented. Only 1%-3% manganese is absorbed via ingestion, while most of the remaining manganese is excreted in the feces. As listed in the United States National Agriculture Library, manganese adequate intake is 1.6-2.3 mg/day for adults. This level of intake is easily achieved without supplementation by a diverse diet including fruits and vegetables, which have higher amounts of manganese than other food types. Patients on a long-term parenteral nutrition should receive manganese supplementation and should be monitored to ensure that circulatory levels of manganese are appropriate.

CLINICAL INTERPRETATION:

Manganese in urine represents the excretion of excess manganese from the body, and may be used to monitor exposure or excessive nutritional intake.
Manganese excretion >50.0 ug/24 hour collection is considered an"Alert Value" in the Mayo Health System.

REFERENCE VALUES:

Lowest reportable: <0.1 ug/24 hour collection

Normal range: 2.0 ug/24 hour collection

Alert value high: >50.0 ug/24 hour collection