First AD

Second AD

A 45-year-old woman with Crohn disease and short gut syndrome from multiple bowel resection presents with headache, a new onset tremor, and change in her gait. She has been dependent on total parenteral nutrition (TPN) for several years.

Manganese toxicity should be on the differential of any patient who is TPN-dependent and presents with neurologic symptoms. The manganese content in TPN, especially when used long-term, can be toxic. It accumulates in the basal ganglia and causes Parkinson-like symptoms.

Gastrointestinal Disorders

Crohn disease patients with short gut syndrome may require total parenteral nutrition to replace nutrients no longer absorbed. But the supplementation has its risks. Can you name the source of the symptoms in this case?  

Vitamin Deficiency or Mineral Toxicity-Your Dx?