Hypermanganesemia has recently been reported in long-term home parenteral nutrition patients receiving routine trace element supplementation. Because the regulation of manganese involves intestinal absorption and biliary excretion, patients receiving parenteral nutrition, especially those with hepatic dysfunction, may be at risk for manganese toxicity. This case study describes a patient in an acute care setting who had been receiving parenteral nutrition for 7 months. When neurologic symptoms developed, she was found to have a whole blood manganese level almost 3 times normal. Manganese was eliminated from the trace element solution, and a whole blood level was rechecked 3 months later, showing a significant decrease and a marked improvement in facial paralysis and headaches.