Manganese (Mn) is an essential element, present in significant concentrations in the central nervous system (CNS) and all other tissues. 1-4 Mn is required for normal immune function, regulation of blood sugar and cellular energy, lipid and carbohydrate metabolism, skeletal cartilage development, reproduction, and brain functions. It participates in metabolic pathways and a co-factor metal for Mn superoxide dismutase and glutamine synthetase. 5,6 The body's requirements for Mn are met through food and drinking water, with adult human consumption ranging from 1 to 10 mg Mn per day, of which about 1-5% is absorbed in the gut. 2,5,7 Homeostatic mechanisms controlling uptake, storage, and elimination of dietary Mn maintain tissue Mn concentrations at a relatively constant level despite widely varying dietary levels of Mn.