•Identify cause (food, supplements, industrial, well
water) and stop
•
•Limit foods – tea, tinned pineapple, ?blackberries,
?home-grown
•
•Assess anaemia, platelet count and liver function –
alkaline phosphatase,
inflammation and refer to specialist if abnormal
•
•Assess neurological status – poor co-ordination or gait
or reduced tapping speed; refer to
neurologist for MRI scan
•
•Limit alcohol if excessive, overweight or abnormal liver
function tests
•
•Assess status of other trace elements, zinc, copper and
iron and treat any other
deficiencies/excesses
•
•Consider giving zinc 10mg x 2/day to reduce manganese absorption
•
•Reassess after 2-3 months, re-measure manganese – whole
blood and plasma zinc and
copper
•
•Elevated levels could take >6 months to return to
normal and brain content is
unlikely to fall