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Manganese, 24 Hour, Urine
Test Code13726
CPT Codes
83785<br><strong>This test code is for New York patient testing. For non-New York patient testing, see test code 37966.</strong>
Preferred Specimen
0.3 mL 24 hour urine submitted in plastic 10 mL urine tube, or clean plastic aliquot container with no metal cap or glued insert
Patient Preparation
High concentrations of gadolinium and iodine are known to interfere with most metal tests. If gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Minimum Volume
0.2 mL
Instructions
1. Collect urine in a clean, all-plastic container without a glued cap insert (Urine 24 Hour Container).
2. Mix urine well before aliquoting.
3. Attach a specimen identification label to a plastic 10-mL urine aliquot tube.
4. Pour urine into the aliquot tube.
5. Place the cap on the tube tightly and send to the laboratory at the temperature indicated in the tests transport instructions.
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.
2. Mix urine well before aliquoting.
3. Attach a specimen identification label to a plastic 10-mL urine aliquot tube.
4. Pour urine into the aliquot tube.
5. Place the cap on the tube tightly and send to the laboratory at the temperature indicated in the tests transport instructions.
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 7 days
Refrigerated: 28 days
Frozen: 28 days
Refrigerated: 28 days
Frozen: 28 days
Methodology
Triple-Quadrupole Inductively Coupled Plasma/Mass Spectrometry
FDA Status
This test was developed and its performance characteristics have been determined by Mayo Clinic Laboratories. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Setup Schedule
Set up: Tues; Report available: 2-8 days
Clinical Significance
Manganese (Mn) is a trace essential element with many industrial uses. Mining as well as iron and steel production have been implicated as occupational sources of exposure. It is principally used in steel production to improve hardness, stiffness, and strength. Mn is a normal constituent of air, soil, water, and food. The primary nonoccupational source of exposure is by eating food or Mn-containing nutritional supplements. Vegetarians who consume foods rich in Mn such as grains, beans, and nuts, as well as heavy tea drinkers, may have a higher intake than the average person. People who smoke tobacco or inhale second-hand smoke are also exposed to Mn at higher levels than nonsmokers.
Inhalation is the primary source of entry for Mn but is also partially absorbed (3%-5%) through the gastrointestinal tract. Only very small amounts of Mn are absorbed dermally. Signs of toxicity may appear quickly, and neurological symptoms are rarely reversible. Mn 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, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgment, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthria, 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) Mn is removed from the blood by the liver where it's conjugated with bile and excreted.
As listed in the United States National Agriculture Library, Mn adequate intake is 1.6 to 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 Mn than other food types. Patients on a long-term parenteral nutrition should receive Mn supplementation and should be monitored to ensure that circulatory levels of Mn are appropriate.
Inhalation is the primary source of entry for Mn but is also partially absorbed (3%-5%) through the gastrointestinal tract. Only very small amounts of Mn are absorbed dermally. Signs of toxicity may appear quickly, and neurological symptoms are rarely reversible. Mn 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, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgment, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthria, 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) Mn is removed from the blood by the liver where it's conjugated with bile and excreted.
As listed in the United States National Agriculture Library, Mn adequate intake is 1.6 to 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 Mn than other food types. Patients on a long-term parenteral nutrition should receive Mn supplementation and should be monitored to ensure that circulatory levels of Mn are appropriate.
