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ATSDR - Public Health Statement: ManganeseThis is a must read has our symptoms

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CONTENTS

1.1 What is manganese?

1.2 What happens to manganese when it enters the environment?

1.3 How might I be exposed to manganese?

1.4 How can manganese enter and leave my body?

1.5 How can manganese affect my health?

1.6 How can manganese affect children?

1.7 How can families reduce their risk of expsoure to manganese?

1.8 Is there a medical test to determine whether I have been exposed

to manganese?

1.9 What recommendations has the federal government made to protect

human health?

1.10 Where can I get more information?

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Division of Toxicology

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September 2000

Public Health Statement

for

Manganese

CAS# 7439-96-5

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This Public Health Statement is the summary chapter from the

Toxicological Profile for manganese. It is one in a series of Public Health

Statements about hazardous substances and their health effects. A shorter

version, the ToxFAQsT, is also available. This information is important because

this substance may harm you. The effects of exposure to any hazardous substance

depend on the dose, the duration, how you are exposed, personal traits and

habits, and whether other chemicals are present. For more information, call the

ATSDR Information Center at 1-.

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This public health statement tells you about manganese and the

effects of exposure.

The Environmental Protection Agency (EPA) identifies the most

serious hazardous waste sites in the nation. These sites make up the National

Priorities List (NPL) and are the sites targeted for long-term federal cleanup

activities. Manganese has been found in at least 603 of the 1,517 cur­rent or

former NPL sites. However, the total number of NPL sites evaluated for this

substance is not known. As more sites are evaluated, the sites at which

manganese is found may increase. This information is important because exposure

to this substance may harm you and because these sites may be sources of

exposure.

When a substance is released from a large area, such as an

industrial plant, or from a container, such as a drum or bottle, it enters the

environment. This release does not always lead to exposure. You are exposed to a

substance only when you come in contact with it. You may be exposed by

breathing, eating, or drinking the substance or by skin contact.

If you are exposed to manganese, many factors determine

whether you'll be harmed. These factors include the dose (how much), the

duration (how long), and how you come in contact with it. You must also consider

the other chemicals you're exposed to and your age, sex, diet, family traits,

lifestyle, and state of health. This chapter discusses adverse (negative)

effects from exposure to " high levels " or " too much " manganese. In general,

these terms refer to levels of manganese reported in occupational settings, such

as battery plants or smelters. Most people are not likely to be exposed to such

high levels of manganese in a typical day. However, each person's body handles

manganese differently; therefore, it is not possible to predict at what level of

manganese a person would begin to show symptoms of health effects from exposure

to increased manganese.

1.1 What is manganese?

Manganese is a naturally occurring substance found in many

types of rock. Manganese does not have a special taste or smell. Pure manganese

is a silver-colored metal; however, it does not occur in the environment as a

pure metal. Rather, it occurs combined with other substances such as oxygen,

sulfur, and chlorine. These forms (called compounds) are solids that do not

evapo­rate. However, small dust particles of the solid material can become

suspended in air. Also, some manganese compounds can dissolve in water, and low

levels of these compounds are normally present in lakes, streams, and the ocean.

Manganese can change from one compound to another (either by natural processes

or by human activity), but it does not break down or disappear in the

environment.

Rocks with high levels of manganese compounds are mined and

used to produce manganese metal. This manganese metal is mixed with iron to make

various types of steel. Some manganese compounds are used in the production of

batteries, in dietary supplements, and as ingredients in some ceramics,

pesticides, and fertilizers.

Manganese is an essential trace element and is necessary for

good health. The human body typically contains small quantities of manganese,

and under normal circumstances, the body controls these amounts so that neither

too little nor too much is present.

Different forms of manganese are discussed in this profile.

These forms are either inorganic manganese or organic manganese. The inorganic

manganese includes those forms of the element such as combustion products from

cars or trucks, as well as the dusts that are present in steel or battery

factories. Organic forms of manganese that are discussed are a gasoline

additive, two pesticides, and a compound used in hospitals to test if a patient

has certain types of cancer. The profile discusses what is known about the

amount of these compounds that can be toxic to people and how these compounds

can affect people's health.

Chapters 3, 4, and 5 of the toxicological profile have more

information on the properties and uses of manganese and how it behaves in the

environment.

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1.2 What happens to manganese when it enters the environment?

Manganese and manganese compounds exist naturally in the

environment as solids in the soil and as small particles in water. Manganese may

also be present in small dust-like particles in the air. These

manganese-containing particles usually settle out of the air within a few days

depend­ing on their size, weight, density, and the weather conditions. Manganese

exists naturally in rivers and lakes, and is also naturally present in some

underground water. Algae and plankton in the water can consume some manganese

and concentrate it within themselves.

In addition to occurring naturally in the environment,

manganese can be introduced by human activity. Manganese can be released into

the air by industry and by the burning of fossil fuels. More specifically,

sources of airborne manganese include iron- and steel-producing plants, power

plants, coke ovens, and dust from uncontrolled mining operations. Manganese

released from burning a gasoline additive may also be a source of manganese in

the air. Manganese from these human-made sources can enter surface water,

groundwater, and sewage waters. Small manga­nese particles can also be picked up

by water flowing through landfills and soil. The chemical state of manganese and

the type of soil determine how fast it moves through the soil and how much is

retained in the soil. Maneb and mancozeb, two pesticides that contain manganese,

may also add to the amount of manganese in the environment when they are applied

to crops or released to the environment from packaging factories. There is

information on the amount of maneb and mancozeb released into the environment

from facilities that make or use these pesticides. However, the amount of

manganese in the environment because of the release and use of these pesticides

is not known.

To avoid staining clothes or plumbing fixtures, the EPA

recommends that the concentration of manganese in drinking water not be more

than 0.05 ppm. FDA has set the same level for bottled water. This concentration

is believed to be more than adequate to protect human health. The EPA has also

established rules that set limits on the amount of manganese that factories can

dump into water. EPA requires factories that use or produce manganese to report

how much they dump in the environment. OSHA has set limits of 5 mg/m³ for fume

and 0.2 mg/m³ for particulate matter as the average amounts of manganese in

workplace air over 8-hour workday (OSHA 1998). Similarly, the ACGIH (American

Conference of Governmental Industrial Hygienists) has set a limit of 1 mg/m³ for

manganese fume and 0.2 mg/m³ for the average amount of manganese, either

elemental or as inorganic compounds, that can be present in the air over an

8-hour workday (ACGIH 1998).

For more information on manganese in the environment, see

Chapter 5 of the toxicological profile.

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1.3 How might I be exposed to manganese?

Because manganese is a natural component of the environment,

you are always exposed to low levels of it in water, air, soil, and food. In

drinking water, levels are usually about 0.004 parts manganese per million parts

(ppm) of water. In air, levels are usually about 0.00002 milligrams manganese

per cubic meter (mg/m³) of air. Natural levels in soil usually range from 40 to

900 ppm. Manganese is also a normal part of living things, including both plants

and animals, so it is present in foods. For nearly all people, food is the main

source of manganese, and usual daily intakes range from about 1 to 10 mg/day.

The exact amount you take in depends on your diet.

You are most likely to be exposed to higher-than-usual levels

of manganese or manganese-containing chemicals if you work in a factory where

manganese metal is produced from manganese ores or where manganese compounds are

used to make steel or other products. In these factories you would be exposed

mainly by breathing in manganese dust. If you live near such a factory you could

also be exposed to higher-than-usual levels of manganese dust in the outside

air, although the amounts would be much lower than in the factory. You might be

exposed to higher-than-usual levels if you live near a coal- or oil-burning

factory because manga­nese is released into the air when these fossil fuels are

burned. Some areas of the country use a gasoline that has manganese added to it

to increase performance. You could also be exposed to higher-than-usual levels

of manganese if you live in a major urban area where such gasoline is used, if

you have a job in which you make or have contact with that gasoline every day

(such as a mechanic), or if you are exposed to a high amount of car exhaust on a

daily basis (at bus stops, gas stations, etc.). You can also be exposed to

manganese if you use pesticides that contain it. People who deal with such

pesticides may be exposed through skin contact, but there have been instances in

which workers may have accidentally eaten or inhaled some pesticides. You may

also be exposed to manganese by eating foods that contain small, leftover

amounts (residues) of these pesticides.

If manganese compounds, either naturally-occurring or from a

factory or a hazardous waste site, get into water, you could be exposed to

higher-than-usual levels by drinking the water.

See Chapter 5 of the toxicoloigcal profile for more

information on how you might be exposed to manganese or its compounds.

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1.4 How can manganese enter and leave my body?

Humans are exposed to manganese in the food and water they eat

and drink and in the air they breathe. Infants eat manganese that is present in

breast milk, soy-based infant formulas, or cow's milk. The amount of manganese

in these sources is generally not a problem, and they provide the manganese that

is necessary for normal functioning of the body. If you live near a hazardous

waste site, you could possibly eat or drink higher-than usual levels of

manganese that are in soil or water or breathe manganese-containing dust

particles in the air that come from the waste site. The contribution of these

exposure routes to manganese's toxicity is uncertain; in general, adverse

effects in people exposed through these routes have only been reported when

environmental manganese levels were quite high. If you get

manganese-contaminated soil or water on your skin, very little will enter your

body, so this is not of concern. If you swallow manganese in water or in soil,

most is excreted in the feces. However, about 3-5% is usually taken up and kept

in the body. If you breathe air containing manganese dust, many of the smaller

dust particles will be trapped in your lungs. Some of the manganese in these

small particles may then dissolve in the lungs and enter the blood. The exact

amount that may enter the blood is not known. Larger particles and those that do

not dissolve will be coughed up, in a sticky layer of mucus, out of the lungs

and into the throat, where they will be swallowed and will enter the stomach.

Manganese is a regular part of the human body; it is a

necessary component in order for the body to work properly. The body normally

controls the amount of absorbed manganese. For example, if large amounts of

manganese are eaten in the diet, the body excretes large amounts in the feces.

Therefore, the total amount of manganese in the body tends to stay about the

same, even when exposure rates are higher or lower than usual. However, if too

much manganese is taken in, the body may not be able to adjust for the added

amount.

See Chapter 2 of the toxicological profile for more

information on how manganese enters and leaves the body.

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1.5 How can manganese affect my health?

To protect the public from the harmful effects of toxic

chemicals and to find ways to treat people who have been harmed, scientists use

many tests.

One way to see if a chemical will hurt people is to learn how

the chemical is absorbed, used, and released by the body; for some chemicals,

animal testing may be necessary. Animal testing may also be used to identify

health effects such as cancer or birth defects. Without laboratory animals,

scientists would lose a basic method to get information needed to make wise

decisions to protect public health. Scientists have the responsibility to treat

research animals with care and compassion. Laws today protect the welfare of

research animals, and scientists must comply with strict animal care guidelines.

Manganese is an essential nutrient, and eating a small amount

of it each day is important to stay healthy. Manganese is present in many foods,

including grains and cereals, and is found in high concentra­tions in many

foods, such as tea. The amount of manganese in typical western diets (about 1-10

mg manganese per day) appears to be enough to meet daily needs. Human diets with

too little manganese can lead to slowed blood clotting, skin problems, changes

in hair color, lowered cholesterol levels, and other alterations in metabolism.

In animals, eating too little manganese can interfere with normal growth, bone

formation, and reproduction.

Too much manganese may also cause serious illness. Most

manganese compounds seem to cause the same effects, although it is unknown

whether exposure to different manganese compounds results in slight differences

in adverse effects. Manganese miners or steel workers exposed to high levels of

manganese dust in air may have mental and emotional disturbances, and their body

movements may become slow and clumsy. This combination of symptoms is a disease

called 'manganism.' Workers do not usually develop symptoms of manganism unless

they have been exposed to manganese for many months or years. Manganism occurs

because too much manganese injures a part of the brain that helps control body

movements. Some of the symptoms of manganism may improve upon certain medical

treatments, but the improvements are usually temporary, and the brain injury is

permanent. Manganism has been reported most often in miners. It has only been

reported a few times in other workers exposed to the metal, such as steel

workers. The symptoms most commonly observed in occupational workers (other than

miners) include difficulty in the following motor skills: holding one's hand

steady, perform­ing fast hand movements, and maintaining balance when tested.

These symptoms are not as severe as those related to manganism, indicating that

the effects caused by manganese over-exposure are related to the level of

exposure.

Most people who inhale manganese are involved in jobs where

they are exposed to the metal. There is a possibility that people can be exposed

to manganese in the air if they live near a plant that uses manganese, or if

they live in a high traffic area and the automobiles burn manganese in the

gasoline. A recent study showed that people who inhaled manganese from the air

and who had high levels of manganese in their blood showed signs of neurological

problems that were similar to those reported in occupationally-exposed persons.

The neurological problems were most significant in the people aged 50 years and

older.

It is not certain whether eating or drinking too much

manganese can cause symptoms of manganism. In one report, people who drank water

containing high concentrations of manganese developed a number of symptoms that

were similar to those seen in manganese miners and steel workers. However, it is

not clear whether these effects were caused by the manganese alone; other

effects were noted, suggesting that other compounds may have been involved. In

another report, people who drank water with above-average levels of manganese

seemed to have a slightly higher frequency of symptoms such as weakness, stiff

muscles, and trembling hands. However, these symptoms are not specific for

manganism and might have been caused by other factors. Another study discovered

that people who ate food with high concentrations of manganese, while also

eating a diet low in magnesium, suffered nerve disease. Another study in adults

over 40 years old who drank water with high manganese levels for at least 10

years reported no changes in behavior and no symptoms, that commonly occur in

people exposed to excess levels of manganese. Two studies reported that children

who drank water and who ate food with higher-than-usual levels of manganese did

more poorly in school and on specific tests that measure coordination than

children who had not eaten above-average amounts of manganese. However, these

studies included several limitations; it is not clear whether the adverse

effects in the children were caused only by eating too much manganese.

Studies in animals have shown that very high levels of

manganese in food or water can cause changes in the brain. This information

suggests that high levels of manganese in food or water might cause changes in

the function of the nervous system. However, people exposed to manganese

concentrations typically found in food, water, or air have little cause for

concern.

Breathing too much manganese dust over a short or long time

can cause irritation of the lungs. Sometimes this makes breathing difficult, and

it can also increase the chances of getting a lung infection, such as pneumonia.

However, this can happen from breathing in many kinds of dust particles and not

just those that contain manganese.

A common effect in men who are exposed to high levels (levels

seen in some occupational studies) of manganese dust in the air over a long time

is impotence. Studies in animals show that too much manganese may also injure

the testes. Much less is known about the effects of too much manganese on

women's ability to reproduce. Studies in animals suggest that too much manganese

can negatively affect a female's ability to reproduce.

No studies have been done to determine whether breathing

manganese dust causes cancer in humans. Some studies in animals show that eating

large amounts of manganese might increase the chances of getting cancer.

However, only a few animals in these studies developed cancer, and it was

difficult to tell whether the tumors were really caused by the excess manganese.

Thus, there is little evidence to suggest that cancer is a major concern for

people exposed to manganese in the environment or near hazardous waste sites.

The EPA has determined that manganese is not classifiable as a human carcinogen.

One compound that contains manganese, potassium permanganate,

damages the skin. Two other compounds that contain manganese, the pesticides

maneb and mancozeb, can cause skin reac­tions in people who have allergies to

these pesticides. Skin rashes can occur because of these allergies, but once the

exposure to the pesticide is stopped, the rashes and any other effects will

usually go away. However, once a person has developed an allergy to a particular

manganese-containing pesticide, that person may have similar allergic reactions

to different, but related, pesticides.

The negative adverse effects of exposure to excess levels of

manganese have been observed in all ages. Several studies in humans and animals

indicate that the elderly may be a potentially susceptible population to the

adverse effects of manganese exposure. Further, studies show that the young may

also be a susceptible population. Effects of exposure to high levels of

manganese in children are discussed in Section 1.6.

Chapter 2 of the toxicological profile has more information on

the health effects of manganese exposure in humans and animals.

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1.6 How can manganese affect children?

This section discusses potential health effects from exposures

during the period from conception to maturity at 18 years of age in humans.

Potential effects on children resulting from exposures of the parents are also

considered.

Children, like adults, are primarily exposed to manganese

through the food they eat. The human diet typically provides the amount of

manganese required for the normal functioning of a healthy body. Children, like

adults, can also inhale manganese if it is present in the air.

In their daily activities, children contact a very different

physical environment than adults do. Therefore, their behavior in their

surroundings might allow them to contact manganese in ways in which adults

typically would not. Young children sometimes eat dirt on purpose and often eat

dirt accidentally by putting their hands into their mouths. If the soil contains

manganese, children can be exposed to manganese in this unique way. However,

there is little information on how well manganese in soil can be taken up from

the stomach into the body if children eat it. Most soils contain a background

concentration of the metal (values range from 40-900 ppm, with an average

estimated at 330 ppm). However, eating small amounts of soils containing

background concentrations of manganese should not cause harm to most healthy

children because of the tight control the body has over the amount of manganese

it maintains.

No studies have discovered how much manganese children need to

stay healthy or how much manganese they absorb from all environmental sources.

Therefore, it is not known whether the amount of manganese per kilogram of body

weight that children take into their bodies through eating or breathing is

different from that amount in adults. Animal studies indicate that infant rats

take in and retain more manganese than adult rats; therefore, infants and young

children may also take up more manganese than adults.

Children who ate or drank above-average amounts of manganese

did more poorly in school and on tests that measure coordination than other

children who had not eaten increased amounts of manganese. Although the amounts

of manganese in the water and food were measured, the amounts eaten by the

children were not known. However, the studies that reported these results in

children had several flaws; it is unclear if eating too much manganese was the

cause for the difference in the children.

Adverse health effects have also been observed in children who

cannot get rid of extra manganese from their body, such as children whose livers

do not function properly. These effects include a lack of control over movements

in their arms and legs, a tendency to overbalance when walking, and

uncontrollable shaking in their arms and hands. In addition to children with

problems removing excess manganese from their bodies, some, but not all,

children who must have liquid-form nutrition injected into their veins, called

total parenteral nutrition (TPN), have also shown these effects. In the cases

involving liquid diets, the children had no control over the foods they ate, and

there may have been too much manganese in the liquid food. These same effects

have been observed in adults with similar liver conditions or on liquid diets.

More serious health effects are typically observed only in people who have

inhaled manganese in a work environment for many years. These occupational

environments tend to have manganese levels that are much higher than the typical

environment (10-70 nanograms/m³ in urban areas with no significant sources of

manganese). The severe and permanent neurological effects and mood swings that

might be anticipated from occupational studies of adults have not been reported

in children. Workers who have been overexposed to manganese particles in the air

have suffered wild mood swings, uncontrollable laughter or crying at

inappropriate times, and abnormal facial expressions (stiff with grimacing or

blank with no expression). Similar effects have also been seen in monkeys who

have been injected with low levels of manganese for only a few days. These

serious effects of manganese overexposure might be expected in children who have

been exposed to high concentrations of manganese for extended periods, although

it is not known for sure. The levels of manganese children would have to breathe

or eat before they showed these effects is not known.

Limited information suggests that higher-than-usual amounts of

manganese can cause birth defects. One study in humans suggests that high levels

of exposure to environmental manganese (in the soil, water, air, or food) might

increase the chances of birth defects. However, it is not possible to reach a

conclusion from this study because other factors were present that may have

caused the birth defects. Studies involving animals exposed to manganese in air

are limited. One study in animals shows that exposure of pregnant females to

high levels of manganese in air resulted in decreased body weight in the pups.

Other studies investigating birth defects have used different exposure methods.

One study that involved exposing pregnant rats and their offspring to manganese

in drinking water (over 21,000 times the amount that is typically recom­mended

as safe for people to eat each day) found that the rat pups had a short-lived

decrease in body weight and an increase in activity. Higher concentrations

(approximately 37,000 times the recommended safe amount for humans) of manganese

provided in food to animals were associated with decreased activity, while lower

concentrations (approximately 1,100 times the recommended safe amount for

humans) given all at once each day to rodents can cause delays in the growth of

reproductive organs, decreased pup weight, mistakes in skeletal formation,

behavioral differences in animals, and changes in the brain.

Other studies in which pregnant animals have been injected

with manganese show that negative effects can be seen in unborn pups. These

studies have reported delays in formation of skeletal bones and internal organs,

suggesting that the skeletal system is a target for birth defects caused by

manganese. However, except when manganese is administered via a liquid form of

nutrition injected into their veins, humans are not exposed to manganese through

injection.

Because manganese is a normal part of the human body, it is

always present in the tissues and bloodstream of the mother; in addition, it can

cross the placenta and enter an unborn baby. Manganese has been measured in

plasma from the umbilical cord blood of premature and full_term babies, as well

as in the blood of their mothers. The concentrations of manganese found in

full_term babies were slightly higher than the concentrations found in premature

babies, though these levels were not significantly different. Also, manganese

levels in the livers of pregnant rats were much higher than those in

non-pregnant rats, and the manganese levels in their unborn pups were higher

than usual. Although the few available animal studies indicate that excess

manganese interferes with normal development of the fetus, the relevance of

these studies to humans is not known. There is no information available on the

effects in pregnant women from exposure to excess levels of manganese in air,

food, or water.

Manganese is necessary for proper nutrition for a rapidly

growing infant. The element is present in breast milk at approximately 4-10

µg/L, an amount that appears to be adequate for a nursing baby. Studies show

that infant formulas contain more manganese than breast milk, but that infants

absorb the same proportion of manganese from infant formulas, cow's milk, and

breast milk. However, because cow milk formulas and soy formulas contain much

larger amounts of manganese than breast milk, infants who are fed these formulas

ingest much higher amounts of manganese than breast-fed infants. Whether these

higher amounts of manganese are unhealthy for the infant is unknown.

Sections 2.6 and 5.6 of the toxicological profile contain more

information on the effects of manganese on children.

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1.7 How can families reduce their risk of expsoure to

manganese?

If your doctor finds that you have been exposed to significant

amounts of manganese, ask whether your children might also be exposed. Your

doctor might need to ask your state health department to investigate.

In typical situations, there is no need to reduce exposure to

manganese. A healthy body regulates the amount of manganese that it either keeps

or eliminates based on the foods eaten and the air breathed. Because manganese

is the twelfth most common element in the earth's crust, it is always found in

measurable concentrations in topsoil. If young children eat soil, it is unknown

whether they are able to absorb the manganese in the soil. No studies were

located that would show how much, if any, manganese can be absorbed after eating

soil. Despite this lack of infor­mtion, manganese concentrations in soil are not

typically high, and therefore, the amount of manganese that children might take

in from eating soil should not be a great concern. However, if soil in your

neighborhood contains large amounts of manganese from hazardous waste or other

environmental sources, you should prevent your children from eating it and

discourage children from putting their hands in their mouths or performing other

hand-to-mouth activity.

Manganese is also present in drinking water. The EPA has set a

Secondary Maximum Contaminant Level (MCL) for the metal in drinking water at

0.05 ppm because at higher concentrations it can stain clothes or plumbing

fixtures. The Food and Drug Administration (FDA) has also set this level for

bottled water, and it is believed to be low enough to protect human health.

Individuals with well water that leaves black deposits or dark stains in their

sinks and other fixtures may want to have their water tested for high levels of

manganese.

The exact amounts of manganese necessary for proper body

functioning in an infant or child are not known. However, the effects of getting

too little manganese are well known in adults, and recorded cases of manganese

deficiency are very rare. Therefore, it appears that humans get adequate amounts

of manganese from their diets. Children are not likely to be exposed to toxic

amounts of manganese in the diet. However, manganese can be absorbed in

higher-than-usual amounts if the diet is low in iron. Therefore, it is very

important to provide your child with a well_balanced diet. The Food and

Nutrition Board of the National Research Council (NRC) has not established a

Recommended Daily Allowance for manganese because too little is known about the

dietary requirements of this trace element. However, an Estimated Safe and

Adequate Daily Dietary Intake (ESADDI) for manganese has been estimated as

0.3-0.6 mg/day for infants from birth to 6 months, 0.6-1 mg/day for infants aged

6 months to 1 year, 1-1.5 mg/day for children aged 1-3 years, 1-2 mg/day for

children aged 4-10 years of age, and 2-5 mg/day for children aged 10 years to

adult.

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1.8 Is there a medical test to determine whether I have been

exposed to manganese?

Several tests are available to measure manganese in blood,

urine, hair, or feces. Because manganese is a normal part of the body, some is

always found in tissues or fluids. Concentra­tions in blood, urine, hair, or

feces are often found to be higher than average in groups of people exposed to

higher-than-usual levels of manganese. Because the levels in different people

can vary widely, these methods are not very reliable to determine whether a

single person has been exposed to higher-than-usual levels. However, blood or

urine levels in groups of people who have been exposed to higher-than-usual

amounts are useful indicators of exposure when compared with reference levels

from people who have not been exposed. The normal range of manganese levels in

blood is 4-14 µg/L, 0.97-1.07 µg/L in urine, and 0.15-2.65 µg/L in serum (the

fluid portion of the blood). Because excess manganese is usually removed from

the body within a few days, past exposures are difficult to measure with common

laboratory tests.

A medical test known as magnetic resonance imaging, or MRI,

can detect the presence of increased amounts of manganese in the brain. This

test has been very useful in determining whether people have accumulated

higher_than_usual amounts of manganese in the body. This tool is often used when

a person is showing severe signs of manganese toxicity, as in manganism, or in

other diseases that affect the brain, such as Parkinson's disease or Alzheimer's

disease. The results must be used along with a complete medical history because

other diseases affecting the brain can cause abnormal MRI scans. MRI is not

useful, though, in determining the source of increased exposure or in

establishing the amount of manganese that you might have been exposed to.

Furthermore, MRI analysis will not necessarily detect manganese in the brain

after exposure to the metal has ceased. Most people who have increased manganese

concentrations in their body do so as a result of increased exposure to the

compound (most often by work exposures); others have increased levels because

they are unable to clear manganese from their bodies. A medical test would not

be able to tell the difference between these two possibilities, and further

testing would be needed to find the cause of increased exposure. Also, exposure

to high levels of manganese (such as in the case of manganese miners) may cause

a permanent effect on the brain, depending on the length and level of manganese

exposure.

Chapters 2 and 6 of the toxicological profile have more

information on how manganese can be measured in exposed humans.

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1.9 What recommendations has the federal government made to

protect human health?

The federal government develops regulations and

recommendations to protect public health. Regulations can be enforced by law.

Federal agencies that develop regulations for toxic substances include the

Environmental Protection Agency (EPA), the Occupational Safety and Health

Administration (OSHA), and the Food and Drug Administration (FDA).

Recommenda­tions provide valuable guidelines to protect public health but cannot

be enforced by law. Federal organizations that develop recommendations for toxic

substances include the Agency for Toxic Substances and Disease Registry (ATSDR)

and the National Institute for Occupational Safety and Health (NIOSH).

Regulations and recommendations can be expressed in

not-to-exceed levels in air, water, soil, or food that are usually based on

levels that affect animals; then they are adjusted to help protect people.

Sometimes these not-to-exceed levels differ among federal organizations because

of different exposure times (an 8-hour workday or a 24-hour day), the use of

different animal studies, or other factors.

Recommendations and regulations are also periodically updated

as more information becomes available. For the most current information, check

with the federal agency or organization that provides it. Some regulations and

recommendations for manganese include the following:

To avoid staining clothes or plumbing fixtures, the EPA

recommends that the concentration of manganese in drinking water be not more

than 0.05 ppm. FDA has set the same level for bottled water. This concentration

is believed to be more than adequate to protect human health. The EPA has also

established rules that set limits on the amount of manganese that factories can

dump into water. EPA requires factories that use or produce manganese to report

how much they dump in the environment. OSHA has set a limit of 5 mg/m³ for the

average amount of manganese in workplace air over an 8-hour workday .

Manganese is an essential element of the diet. Like a number

of metals (for example, chromium, copper, iron, and zinc) manganese is important

in the normal functioning of the body. Therefore, both too little or too much

can be harmful. The Food and Nutrition Board of the National Research Council

has set an ESADDI for manganese. The ESADDI for manganese ranges from 0.3 up to

5 mg/day for different age groups (1-10 mg/day is about the amount found in the

diet of an adult; ; ).

Chapter 7 of the toxicological profile has more information on

governmental rules regarding manganese.

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1.10 Where can I get more information?

If you have any more questions or concerns, please contact

your community or state health or environmental quality department or:

Agency for Toxic Substances and Disease Registry

Division of Toxicology

1600 Clifton Road NE, Mailstop F-32

Atlanta, GA 30333

Information line and technical assistance:

Phone:

FAX:

ATSDR can also tell you the location of occupational and

environmental health clinics. These clinics specialize in recognizing,

evaluating, and treating illnesses resulting from exposure to hazardous

substances.

To order toxicological profiles, contact:

National Technical Information Service

5285 Port Royal Road

Springfield, VA 22161

Phone: or

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References

Agency for Toxic Substances and Disease Registry (ATSDR).

2000. Toxicological profile for manganese. Update. Atlanta, GA: U.S. Department

of Health and Human Services, Public Health Service.

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