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  • Abdomen Acute
  • Abdominal Infarction
  • Abdominal Pain
  • Abdominal Pain Chronic
  • Abdominal Pain-Lower Abdomen
  • Abdominal Pain-Upper AbdomenAbdominal
  • Absence Seizure
  • Abuse-Psychological, Physical, Or Sexual
  • Acoustic Neuroma
  • Acromegaly
  • Acute Appendicitis, Unspecified
  • Acute Intermittent Porphyria (AIP)
  • Acute Renal Failure
  • Acute Stress Disorder
  • Addison's Disease
  • ADHD Adult
  • ADHD-Sleep Disorder Related To ADHD
  • Adjustment Disorder
  • Adrenal Disease
  • Adrenal Disease-Cushing's
  • Adrenal Insufficiency-Addison's Disease
  • Adult ADHD (ADD)
  • Agoraphobia
  • AIDS-Acquired Immune Deficiency Syndrome
  • Akathisia
  • Akathisia Medication-induced
  • Alcohol Abuse
  • Alcohol Dependence
  • Alcohol Dependence In Remission
  • Alcohol Use Disorder
  • Alcohol-Flush-Aldehyde Dehydrogenase Deficiency
  • Aldehyde Dehydrogenase Deficiency
  • Alopecia Areata
  • Alopecia Secondary To Childbirth
  • Alopecia Universalis
  • Alopecia-Male Pattern Baldness
  • Alopecia-Medication-induced
  • Alopecia-Telogen Effluvium
  • Alopecia-Traction
  • Alport Syndrome
  • Aluminum Toxicity
  • Alzheimer's
  • Alzheimer's Dementia
  • Amnestic Disorder
  • Amphetamine Abuse
  • Amphetamine Dependence
  • Amphetamine Dependence In Remission
  • Amyloidosis
  • Amyotrophic Lateral Sclerosis
  • Amyotrophic Lateral Sclerosis (ALS)
  • Anemia
  • Aneurysmal Subarachnoid Hemorrhage
  • Angina Pectoris
  • Angina Unstable
  • Ankylosing Spondylitis
  • Anorexia Nervosa
  • Anorgasmia
  • Antisocial Personality Disorder
  • Anxiety Disorder
  • Anxiety Disorder Due To Another Medical Condition
  • Anxiety-Agoraphobia
  • Anxiety-Organic
  • Anxiety-PTSD (Post-traumatic Stress Disorder)
  • Anxiety-Specific Phobia
  • Aortic Aneurysm
  • Appendicitis
  • Appendicitis-Acute, Unspecified
  • Arrhythmia
  • Arsenic Toxicity
  • Arthritis
  • Arthritis-Cervical
  • Arthritis-Osteoarthritis
  • Arthritis-Rheumatoid
  • Asperger's Syndrome
  • Asthma
  • Atonic Seizure
  • Atypical Depression
  • Auditory Hallucinations
  • Auriculotemporal Nerve Syndrome
  • Autoimmune Hepatitis
  • Avitaminosis
  • Avoidant Personality Disorder
  • B12 Deficiency
  • Bacterial Preexisting Heart Conditions
  • Balance-Disequilibrium-Benign Positional Vertigo
  • Balance-Disequilibrium-Cerebellar Disease
  • Balance-Disequilibrium-Friedreich's Ataxia
  • Balance-Disequilibrium-Labyrinthitis-Acute
  • Balance-Disequilibrium-Vertigo-Central
  • Balance-Disequilibrium-Vertigo-Medication-induced
  • Balance-Disequilibrium-Vertigo-Peripheral
  • Balance-Disequilibrium-Vertigo-Toxin-induced
  • Balance-Disequilibrium-Vestibular-Neuritis
  • Balding-Alopecia Areata
  • Balding-Alopecia Secondary To Childbirth
  • Balding-Alopecia Universalis
  • Balding-Alopecia-Male Pattern
  • Balding-Alopecia-Medication-induced
  • Balding-Alopecia-Traction
  • Balding-Telogen Effluvium
  • Barbiturate -use
  • Barbiturate Abuse
  • Barbiturate Dependence
  • Benzodiazepine Abuse
  • Benzodiazepine Dependence
  • Benzodiazepine Dependence In Remission
  • Benzodiazepine Use
  • Bereavement
  • Bile Duct Obstruction
  • Binge Eating Disorder
  • Bipolar
  • Bipolar Disorder
  • Bipolar Irritability
  • Bipolar-Atypical Depression
  • Bipolar-Dissociative Disorder
  • Bipolar-Dissociative Identity Disorder
  • Bipolar-Irritability
  • Bipolar-Kleptomania
  • Bipolar-Pathological Gambling
  • Bipolar-SAD (Seasonal Affective Disorder)
  • Bladder Disorder
  • Bladder Disorder, Unspecified
  • Bladder Disorder-Unspecified
  • Bladder-Incomplete Bladder Emptying
  • Bladder-Incontinence-Unaware
  • Bladder-Incontinence-Urge Incontinence
  • Bladder-Incontinence-Urinary Stress Incontinence
  • Bladder-Urinary Urgency
  • Bleeding Disorder
  • Blood In The Urine
  • Blood-Anemia
  • Blood-Bleeding Disorder
  • Blood-Epistaxis
  • Blood-Hematemesis
  • Blood-Hematochezia
  • Blood-Hematuria
  • Blood-Hemochromatosis
  • Blood-Hemoptysis
  • Blood-Melena
  • Blood-Polycythemia
  • Blood-Sickle Cell Anemia
  • Blood-Thrombocytopenia
  • Body Dysmorphic Disorder
  • Body Fluid Change
  • Borderline Personality Disorder
  • Boron Toxicity
  • Bowel-Constipation
  • Bowel-Diarrhea
  • Bowel-Diverticulitis
  • Bowel-Diverticulosis
  • Bowel-Essential Palatal Tremor
  • Bowel-Food Allergy
  • Bowel-Gastritis
  • Bowel-Gastroenteritis
  • Bowel-Hiatal Hernia
  • Bowel-Lactase Deficiency
  • Bowel-Nutrition-Gluten-Celiac Disease
  • Bowel-Nutrition-Lactose Intolerance
  • Bowel-Nutrition-Malabsorption
  • Bowel-Nutrition-Malnutrition
  • Bowel-Nutrition-Tropical Sprue
  • Bowel-Pain-Abdomen
  • Bowel-Pain-Abdomen-Acute
  • Bowel-Pain-Abdomen-Chronic
  • Bowel-Pain-Abdomen-Infarction
  • Bowel-Pain-Abdomen-Lower
  • Bowel-Pain-Abdomen-Upper
  • Bowel-Pain-Abdomen-Visceral
  • Bowel-Pain-Abdomen-Viscus-Perforation
  • Bowel-Pain-Erosive Esophagitis
  • Bowel-Pain-Heartburn-GERD
  • Bowel-Pain-IBS
  • Bowel-Pain-Obstruction
  • Bowel-Pain-Peritonitis
  • Bowel-Pain-PUD (Peptic Ulcer Disease)
  • Bowel-Pain-Regional Enteritis
  • Bowel-Pain-Ulcer
  • Bowel-Pain-Ulcer-Gastric
  • Bowel-Pain-Ulcer-Small Intestine-Duodenal
  • Bowel-Pain-Ulcer-Zollinger-Ellison Syndrome
  • Brain Dementia-Amnestic Disorder
  • Branchial Neuralgia
  • Bronchiectasis
  • Bronchitis
  • Bruxism (teeth Grinding)
  • Bulimia
  • Caffeine Dependence
  • Caffeine Intoxication
  • Caffeine-induced Sleep Disorder
  • Cancer
  • Cancer-Bladder
  • Cancer-Breast
  • Cancer-Cervical
  • Cancer-Colon
  • Cancer-Esophageal
  • Cancer-Gastrointestinal
  • Cancer-Kidney
  • Cancer-Leukemia
  • Cancer-Leukoplakia
  • Cancer-Lung
  • Cancer-Lymphoma
  • Cancer-Malignant Neoplasm: Mouth, Unspecified
  • Cancer-Medullary Thyroid Carcinoma
  • Cancer-Melanoma
  • Cancer-Mouth
  • Cancer-Multiple Myeloma
  • Cancer-Ovarian
  • Cancer-Pancreatic
  • Cancer-Pituitary
  • Cancer-Prostate
  • Cancer-Renal Cell Carcinoma
  • Cancer-Skin
  • Cancer-Stomach
  • Carbon Monoxide Poisoning
  • Carcinoid
  • Cataract
  • Cerebellar Disease
  • Cervical Spondylosis
  • Charcot-Marie-Tooth Disease
  • Charles Bonnet Syndrome
  • Chlamydia Infection
  • Choledocholithiasis
  • Cholesteatoma
  • Chorea Gravidarum
  • Chronic Daily Headache
  • Chronic Fatigue Syndrome
  • Chronic Kidney Failure (CKD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic Pain
  • Chronic Renal Failure
  • Circadian Rhythm Sleep Disorder
  • Cluster Headache
  • Cocaine Abuse
  • Cocaine Dependence
  • Cocaine Dependence In Remission
  • Coital Cephalgia
  • Coital Cephalgia-dull Type
  • Coital Cephalgia-explosive Type
  • Coital Cephalgia-postural Type
  • Collagen Vascular Disease
  • Conduct Disorder
  • Congestion-Drug-induced
  • Congestive Heart Failure
  • Congestive Heart Failure (CHF)
  • Constipation
  • Conversion Disorder
  • COPD
  • Costochondritis
  • Cranial Nerve Palsy
  • Creutzfeldt-Jakob
  • Creutzfeldt-Jakob Disease
  • Crohn's Disease Or Regional Enteritis
  • Cushing's Disease
  • Cystic Fibrosis
  • Cystitis
  • Cystitis, Unspecified
  • Deep Vein Thrombosis
  • Dehydration
  • Delirium
  • Delirium-Aneurysmal Subarachnoid Hemorrhage
  • Delirium-Lewy Body Dementia
  • Delirium-Postconcussion Syndrome
  • Delirium-Traumatic Brain Injury
  • Delusional Disorder
  • Delusional Disorder-erotomanic
  • Delusional Disorder-jealousy
  • Delusional Erotomania
  • Delusional Jealousy
  • Dementia
  • Dementia Amnestic Disorder
  • Dementia NOS
  • Dementia Vascular
  • Dementia-Alzheimers
  • Dental-Poor Fitting Dentures
  • Dental-Poor Hygiene
  • Dependent Personality
  • Depersonalization Disorder
  • Depression
  • Depression-Bereavement
  • Dermatopolymyositis
  • Diabetes Insipidus
  • Diabetes Mellitus
  • Diarrhea
  • Disease Of The Small Intestine, Unspecified
  • Disease Of Anus And Rectum, Unspecified
  • Disease Of Biliary Tract, Unspecified
  • Disease Of Intestine, Unspecified-Colon Proximal
  • Disease Of Intestine, Unspecified-Small Intestine
  • Disease Of Stomach And Duodenum, Unspecified
  • Disease Of The Proximal Colon, Unspecified
  • Disequilibrium-Benign Paroxysmal Positional Vertigo (BPPV)
  • Disequilibrium-Central Vertigo
  • Disequilibrium-Cerebellar Disease
  • Disequilibrium-Friedreich\'s Ataxia
  • Disequilibrium-Labyrinthitis Acute
  • Disequilibrium-Vertigo-Medication-induced
  • Disequilibrium-Vertigo-Peripheral
  • Disequilibrium-Vertigo-Toxin-induced
  • Disequilibrium-Vestibular Neuritis
  • Disorder Of Brain, Unspecified-Brainstem Or Pons
  • Disorder Of Brain, Unspecified-Hemisphere
  • Disorder Of The Brainstem Or Pons, Unspecified
  • Disorder Of The Cerebral Hemisphere, Unspecified
  • Disorder-Body Dysmorphic
  • Disorder-Impulse Control
  • Disorder-Intermittent Explosive
  • Disruptive Behavior Disorder
  • Disruptive-Conduct Disorder
  • Dissociative Disorder
  • Dissociative Identity Disorder
  • Dissociative-Depersonalization Disorder
  • Diuretic-induced Hypokalemia
  • Diverticulitis
  • Diverticulosis
  • Drug Induced Edema
  • Dry Mouth
  • Dyspareunia
  • Dysthymia
  • Early Morning Awakening
  • Eating Disorder
  • Eating Disorder, Medication-induced
  • Eating Disorder-Binge
  • Eating-Anorexia Nervosa
  • Eating-Bulimia
  • Eating-Laxative/Diuretic Abuse
  • Eating-Obesity
  • Eating-Reactive Hyperphagia
  • Eating-Weight Gain-Drug-induced
  • Edema
  • Edema-Drug Induced
  • Electrolytes-Magnesium-Hypomagnesemia
  • Electrolytes-Potassium Deficiency
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Endocrine Disease-Adrenal
  • Endocrine-Adrenal Disease
  • Endocrine-Adrenal Insufficiency-Addison's Disease
  • Endocrine-Adrenal-Cushing's
  • Endocrine-Adrenal-Hyperaldosteronism
  • Endocrine-Carcinoid
  • Endocrine-Diabetes Mellitus
  • Endocrine-Diabetes Mellitus-Hypoglycemia
  • Endocrine-Gout
  • Endocrine-Hyperparathyroidism
  • Endocrine-Hyperparathyroidism - Primary Type
  • Endocrine-Hyperparathyroidism - Tertiary Type
  • Endocrine-Hypogonadism
  • Endocrine-Hypoparathyroidism-reversable
  • Endocrine-Hypopituitarism
  • Endocrine-Hypothyroidism
  • Endocrine-Metabolic Syndrome
  • Endocrine-Pancreatic Disease
  • Endocrine-Pancreatitis
  • Endocrine-Pheochromocytoma
  • Endocrine-Pituitary Adenoma
  • Endocrine-Porphyria Acute Intermittent
  • Endocrine-Thyroid-Hyper
  • Endocrine-Thyroid-Hypo
  • Enuresis
  • Enuresis/Bedwetting
  • Epilepsy-Seizure-Absence (petit Mal)
  • Epistaxis
  • Erectile Dysfunction
  • Erosive Esophagitis
  • Erythema-Drug Induced
  • Essential Palatal Tremor
  • Essential Tremor
  • Estrogen Related Hair Growth
  • Excessive Daytime Sleepiness
  • Exhibitionism
  • Eye-Cataract
  • Eye-Glaucoma
  • Factitious Disorder
  • Fainting
  • Fatigue
  • Fatigue-Chronic Fatigue Syndrome
  • Fatigue-Myasthenia Gravis
  • Female Orgasmic Disorder
  • Female Pattern Baldness
  • Female Sexual Arousal Disorder
  • Fetishism
  • Fibromyalgia
  • Fluid-Dehydration
  • Fluid-Polydipsia Psychogenic
  • Fluid-Polydipsia Secondary
  • Fluid-Weight Change
  • Flush-Aldehyde Dehydrogenase Deficiency
  • Flushing
  • Flushing Of Skin Due To A Spinal Cord Lesion Above T6
  • Flushing Of The Skin
  • Flushing-Drug Induced
  • Flushing-Gustatory Flushing Syndrome
  • Flushing-Harlequin Syndrome
  • Flushing-Mastocytosis
  • Flushing-VIPoma
  • Folic Acid Deficiency
  • Food Allergy
  • Friedreich\'s Ataxia
  • Frotteurism
  • Gallbladder Disease
  • Gallbladder Disease-choledocholithiasis
  • Gastric Or Peptic Ulcer
  • Gastritis
  • Gastroenteritis
  • Gastroesophageal Reflux Disease (GERD)
  • Gender Identity Disorder
  • Generalized Anxiety Disorder
  • Giant Cell Arteritis
  • Gingivitis
  • Glaucoma
  • Glomus Tumor (paraganglioma)
  • Glomus Tumors
  • Gluten-Celiac Disease
  • Gonorrhea
  • Gout
  • Guillain-Barre Syndrome
  • Gustatory Flushing Syndrome
  • Hair-Alopecia-Male Pattern Baldness
  • Hair-Balding-Alopecia Areata
  • Hair-Balding-Alopecia Medication-induced
  • Hair-Balding-Alopecia Secondary To Childbirth
  • Hair-Balding-Alopecia Universalis
  • Hair-Balding-Alopecia-Telogen Effluvim
  • Hair-Balding-Alopecia-Traction
  • Hair-Estrogen Related Hair Growth
  • Hair-Female Pattern Baldness
  • Hair-Tinea Capitis
  • Hair-Trichotillomania
  • Hallucination
  • Hallucination-Gustatory
  • Hallucinations
  • Harlequin Syndrome
  • Head Trauma
  • Head-Trauma To Scalp
  • Headache
  • Headache-Chronic Daily Headache
  • Headache-Cluster Headache
  • Headache-coital Cephalgia
  • Headache-Coital Cephalgia -dull Type
  • Headache-Coital Cephalgia -explosive Type
  • Headache-Coital Cephalgia -postural Type
  • Headache-Hemicrania Continua
  • Headache-Medication Overuse
  • Headache-Migraine
  • Headache-Migraine Probable
  • Headache-Migraine Status
  • Headache-Migraine With Aura
  • Headache-Migraine Without Aura
  • Headache-Migraine-Retinal
  • Headache-Psychogenic
  • Headache-sinus
  • Headache-Tension
  • Hearing
  • Hearing Problem
  • Hearing-Medication-induced Loss
  • Hearing-Meniere's Disease
  • Hearing-Tinnitus
  • Hearing-Traumatic Tinnitus
  • Heart Cardiac
  • Heart Disease
  • Heart-Angina
  • Heart-Angina - Emergency
  • Heart-Arrhythmia
  • Heart-Bacterial Endocarditis
  • Heart-CHF
  • Heart-Claudication-Intermittent
  • Heart-claudication-Neurogenic
  • Heart-HCM
  • Heart-MI
  • Heart-Mitral Stenosis
  • Heart-Pericarditis
  • Heavy Smoker
  • Heavy Tobacco Smoker
  • Hematemesis
  • Hematochezia
  • Hematuria
  • Hemicrania Continua
  • Hemochromatosis
  • Hemoptysis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • Hepatitis G
  • Hepatolenticular Degeneration-Wilson's Disease
  • Heroin Abuse
  • Heroin Dependence
  • Heroin Dependence In Remission
  • Hiatal Hernia
  • Hip Pain
  • Histrionic Personality
  • HIV Infection
  • Homicide
  • Huntington's Disease
  • Hyperaldosteronism
  • Hypercalcemia
  • Hypercholesterolemia
  • Hyperhidrosis-Idiopathic
  • Hyperparathyroidism
  • Hyperparathyroidism - Primary Type
  • Hyperparathyroidism - Tertiary Type
  • Hyperprolactinemia
  • Hypersomnia
  • Hypertension
  • Hyperthyroidism
  • Hypertriglyceridemia
  • Hypertrophic Cardiomyopathy
  • Hypoactive Sexual Desire
  • Hypoactive Sexual Desire Disorder
  • Hypochondriasis
  • Hypoglycemia
  • Hypogonadism
  • Hypokalemia
  • Hypokalemia
  • Hypokalemia-Diuretic-induced
  • Hypomagnesemia
  • Hypoparathyroidism
  • Hypoparathyroidism-reversable
  • Hypopituitarism
  • Hypothyroidism
  • Hypothyroidism
  • Idiopathic Hyperhidrosis
  • Impulse Control Disorder
  • Incomplete Bladder Emptying
  • Incontinence-stress Type
  • Incontinence-unaware Type
  • Incontinence-Urge
  • Incontinence-urge Type
  • Increased Intracranial Pressure
  • Infection-AIDS
  • Infection-Creutzfeldt-Jakob
  • Infection-Gonorrhea
  • Infection-HIV
  • Infection-Lyme Disease
  • Infection-Malaria
  • Infection-Rheumatic Fever
  • Infection-Syphilis
  • Infection-Urinary Schistosomiasis
  • Infection-Viral Infection
  • Inferior Temporal Lobe Seizure
  • Inflammatory Disease Of Uterus, Unspecified
  • Inhalant Abuse
  • Inhalant Dependence In Remission
  • Initial Insomnia
  • Insomnia
  • Insomnial-Early Morning Awakening
  • Intermittent Claudication
  • Intermittent Explosive Disorder
  • Intracranial Pressure - Increased
  • Involuntary Emotional Expression Disorder (IEED)
  • Iron Deficiency
  • Irritable Bowel Syndrome (IBS)
  • Kidney Disease
  • Kidney Stone
  • Kidney-Alport Syndrome
  • Kidney-Chronic Renal Failure
  • Kidney-Diabetes Insipidus
  • Kidney-Pyelonephritis
  • Kidney-Renal Failure
  • Kidney-Renal-Failure-Acute
  • Kidney-Uremia
  • Kleine-Levin Syndrome
  • Kleptomania
  • Knee Pain
  • Labyrinthitis Acute
  • Lactase Deficiency
  • Lactose Intolerance
  • Laxative/Diuretic Abuse
  • Lead Toxicity
  • Learning Disorder
  • Leukoplakia
  • Lewy Body Dementia
  • Liver Cirrhosis
  • Liver Disease
  • Liver Disease - Cirrhosis
  • Liver Disease-autoimmune Hepatitis
  • Liver-Cirrhosis-billary
  • Liver-Common Bile Duct Obstruction
  • Liver-Hepatitis B
  • Liver-Hepatitis C
  • Liver-Hepatitis D
  • Liver-Hepatitis E
  • Liver-Hepatitis G
  • Liver-Hepatolenticular Degeneration-Wilson's Disease
  • Liver-Viral Hepatitis
  • LSD Abuse
  • LSD Dependence
  • LSD Dependence In Remission
  • Lung-Asthma
  • Lung-Bronchiectasis
  • Lung-Bronchitis
  • Lung-COPD
  • Lung-Pleurisy
  • Lung-Pneumonia
  • Lung-Pulmonary Embolism
  • Lung-TB
  • Lupus Erythematosus
  • Lupus Erythematosus-Drug Induced
  • Lyme Disease
  • Magnesium-Hypomagnesemia
  • Malabsorption
  • Malaria
  • Male Orgasmic Disorder
  • Malignant Neoplasm Of Mouth, Unspecified
  • Malnutrition
  • Malnutrition-Gluten-Celiac Disease
  • Manganese Toxicity
  • Marijuana Abuse
  • Marijuana Dependence
  • Marijuana Dependence In Remission
  • Mastocytosis
  • Medication Overuse Headache
  • Medication-induced Eating Disorder
  • Medication-induced Erythema
  • Medication-induced Flushing
  • Medication-induced Hearing Loss
  • Meiges Syndrome
  • Melena
  • Meniere's Disease
  • Menopause
  • Menopause-Drug Induced
  • Menopause-early
  • Menopause-Perimenopause
  • Menopause-Postmenstrual Duress
  • Menopause-surgical
  • Mental Retardation
  • Meprobamate Abuse
  • Meprobamate Dependence
  • Meprobamate Dependence In Remission
  • Meprobamate Use
  • Mercury Toxicity
  • Mescaline Abuse
  • Mescaline Dependence
  • Mescaline Dependence In Remission
  • Metabolic Syndrome
  • Metal Toxicity-Aluminum
  • Metal-Aluminum
  • Metal-Arsenic
  • Metal-Boron
  • Metal-Lead
  • Metal-Mercury
  • Metal-Selenium
  • Metal-Tellurium
  • Metal-Zinc
  • Middle Insomnia
  • Migraine Headache
  • Migraine Headache-probable
  • Migraine Headache-retinal
  • Migraine Headache-status
  • Migraine Headache-with Aura
  • Migraine Headache-without Aura
  • Mitral Valve Stenosis
  • Movement Disorder
  • Movement-Akathisia-Neuroleptic-induced
  • Movement-ALS
  • Movement-Chorea Gravidarum
  • Movement-CTD-Polymyalgia Rheumatica
  • Movement-Dermatopolymyositis
  • Movement-Essential Tremor
  • Movement-Guillain-Barre Syndrome
  • Movement-Huntington's
  • Movement-Myoclonus
  • Movement-Parkinson's
  • Movement-Parkinsonism
  • Movement-Tardive Dyskinesia
  • Movement-Tic Disorder
  • Movement-Tourette's Disorder
  • Movement-Transient Tic Disorder
  • Multiple Sclerosis
  • Myasthenia Gravis
  • Myocardial Infarction
  • Myoclonic Seizure
  • Myoclonus
  • Narcissistic Personality
  • Narcolepsy
  • Nasal Congestion-Rebound Congestion
  • Neurodermatitis
  • Neurofibromatosis
  • Neurofibromatosis-I
  • Neurofibromatosis-II
  • Neurogenic Claudication
  • Neuroleptic Malignant Syndrome
  • Neuropathies
  • Night Eating Syndrome
  • Night Sweats
  • Nightmare Disorder
  • Nocturia
  • Nonadherence
  • Nonne-Milroy's Disease
  • Nose Bleed
  • Nutrition-Iron Deficiency
  • Nutrition-Lactose Intolerance
  • Nutrition-Malabsorption
  • Nutrition-Malnutrition
  • Nutrition-Thiamine B1 Deficiency
  • Nutrition-Tropical Sprue
  • Nutrition-Vitamin-Avitaminosis
  • Nutrition-Vitamin-B12 Deficiency
  • Nutrition-Vitamin-B5-Pantothenic Acid Deficiency
  • Nutrition-Vitamin-B6-Pyridoxine Deficiency
  • Nutrition-Vitamin-B9-Folic Acid Deficiency
  • Nutrition-Vitamin-D Deficiency
  • Obesity
  • Obsessive-compulsive Disorder (OCD)
  • Obstruction Intestinal
  • Obstruction-Common Bile Duct
  • OCD
  • OCD Personality
  • OCD-medication Induced
  • Olfactory Hallucinations
  • Opioid Abuse
  • Opioid Dependence
  • Opioid Dependence In Remission
  • Optic Neuritis
  • Oral Cancer
  • Oral Facial Dystonia
  • Oral-Dry Mouth
  • Oral-Gingivitis
  • Orgasmic Disorder
  • Orgasmic Disorder-Female
  • Orgasmic Disorder-males
  • Orthostasis
  • Osteoporosis
  • Other And Unspecified Lesions Of Oral Mucosa
  • Overactive Bladder
  • Pain Abdominal Chronic
  • Pain Abdominal Infarction
  • Pain Disorder
  • Pain Disorder Due To Anatomical And Psychological Conditions
  • Pain Disorder-Psychiatric
  • Pain Disorder-Psychological & General
  • Pain-Abdomen-Acute
  • Pain-Abdominal
  • Pain-Abdominal-Localized To The Lower Abdomen
  • Pain-Abdominal-Localized To Upper Abdomen
  • Pain-Abdominal-Perforation Of Viscus
  • Pain-Abdominal-Visceral
  • Pain-Bowel-Obstruction
  • Pain-Branchial Neuralgia
  • Pain-Chronic Pain
  • Pain-Costochondritis
  • Pain-Erosive Esophagitis
  • Pain-Gastric Ulcer
  • Pain-Heartburn-Gastroesophageal Reflux Disease
  • Pain-Hip
  • Pain-Irritable Bowel Syndrome (IBS)
  • Pain-Peptic Ulcer Disease (PUD)
  • Pain-Peritonitis
  • Pain-Thalamic Central Pain Syndrome
  • Pain-Ulcer
  • Pain-Ulcer-Duodenal
  • Pain-Ulcer-Zollinger-Ellison Syndrome
  • Pancreatic Disease
  • Pancreatic Disease Unspecified
  • Pancreatitis
  • Panic Attacks
  • Panic Disorder
  • Pantothenic Acid Deficiency
  • Paranoid Personality
  • Paraphilia
  • Parkinson's Disease
  • Partial Seizure
  • Partial Seizures
  • Partialism
  • Pathological Gambling
  • Pathological Gambling-medication Induced
  • PCP Dependence
  • PCP Dependence In Remission
  • Pedophilia
  • Pedophilia Exclusive
  • Pedophilia Limited To Incest
  • Pelvic And Perineal Pain
  • Pelvic Inflammatory Disease
  • Pelvic Inflammatory Disease (PID)
  • Perforation Of Viscus
  • Pericarditis
  • Perimenopause
  • Periodic Limb Movement Disorder
  • Peripheral Neuropathy
  • Peripheral Vascular Disease
  • Peripheral Vascular Disease (PVD)
  • Peritonitis
  • Personality Avoidant
  • Personality Disorder
  • Personality-Antisocial
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  • Manganese Toxicity

    Manganese toxicity, poisoning, or manganism, is a condition resulting from chronic exposure to the element manganese  (Mn). In larger amounts, and apparently with far greater activity by inhalation, manganese can cause a a toxicity syndrome, with neurological damage which is sometimes irreversible.

    Manganese is a mineral element that is both nutritionally essential and potentially toxic.  "Manganese" comes from the Greek word for magic, and it is an essential part of the principal antioxidant enzyme in the energy generator for the cell -- called the mitochondria.

    Manganese is also a co-factor in several other enzymes that are important in the metabolism of carbohydrates, amino acids, and cholesterol, as well as the production of glucose, collagen, cartilage and bone.

    Manganese Exposure

    Exposure to excessive levels of manganese is known to induce psychiatric and motor disorders, including parkinsonian symptoms. In fact, manganese toxicity is a well-recognized health hazard for people who inhale manganese dust, such as occurs with welders and smelters.

    Inhaled manganese is transported directly to the brain and may result in multiple neurologic problems including a permanent neurological disorder with symptoms similar to those of Parkinson's disease. Symptoms including tremors, difficulty walking, and facial muscle spasms. This toxicity syndrome -- called manganism -- is sometimes preceded by psychiatric symptoms, such as irritability, aggressiveness, memory problems, and even hallucinations. 

    Manganism has also occurred in persons receiving total parenteral nutrition, workers exposed to manganese-containing fungicides such as maneb, and abusers of drugs such as methcathinone made with potassium permanganate.

    Another risk factor for manganism is iron deficiency, as it has been shown to increase the risk of manganese accumulation in the brain.

    Additionally, recent studies have shown that children exposed to high levels of manganese through drinking water experience cognitive and behavioral deficits, and high levels of manganese in tap water has been associated with hyperactive behavioral disorders.

    Manganese Elimination 

    Manganese is eliminated from the body mainly in the bile (made by the liver). Thus, impaired liver function may lead to decreased manganese excretion. For example, blockage of the normal flow of bile in the liver (cholestasis) increases the risk of manganese poisoning. This impaired metabolism and excretion of manganese by a cirrhotic or otherwise failing liver can cause deposition of manganese in the brain, leading to development of characteristic neuropsychiatric manifestations. This manganese accumulation in the brain appears to contribute to the neurological problems and Parkinson's disease-like symptoms that are commonly seen in these disorders of the liver.

    It the MRI below, the arrows point to areas of signal enhancement in the basal ganglia structures, globus pallidus and lenticular nucleus, due to deposition of manganese in a person with with tremors, ataxic gait, apathy and memory impairment secondary to liver failure. 

     

    In addition, environmental or occupational inhalation of manganese can cause an inflammatory response in the lungs, and can cause cough, acute bronchitis, and decreased lung function.

    Symptoms of manganese toxicity generally appear slowly over a period of months to years; therefore, manganese supplementation beyond 100% of the recommended daily allowance (2 mg/day) is not recommended.

    Excessive exposure to manganese may be confirmed by measurement of blood or urine manganese concentrations; however, serum manganese levels are NOT a good indicator of brain levels.

    Researchers from Purdue University, using magnetic resonance spectroscopy (MRS), found that brain levels of γ-aminobutyric acid (GABA), N-acetylaspartate (NAA), and other brain metabolites in male smelters were altered as a consequence of manganese exposure, including neuronal dysfunction in a brain area not primarily targeted by manganese deposition.

    This noninvasive MRS measurement of GABA and NAA may become a powerful tool for detecting presymptomatic effects of manganese neurotoxicity.

    If you believe you have symptoms of manganese toxicity and you are in the United States, then contact the Poison Help Line at 1-800-222-1222. This service provides a primary resource for poisoning information and helps reduce costly emergency department visits through in-home treatment. Alternatively, you can contact your healthcare provider or see a Family Practice, Internal Medicine, or Hematology specialist.

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