Copper Deficiency during Total Parenteral Nutrition: Clinical Analysis of Three Cases

Abstract

Three adult cases in which copper deficiency developed during long-term total parenteral nutrition (TPN) without copper supplementation have been described, together with a brief review of the literature. All three patients were suffering from malabsorption when TPN was instituted, and overt symptoms of copper deficiency developed an average of 5.8 months after the start of TPN. Clinically, leukopenia with neutropenia and low plasma levels of copper and ceruloplasmin were seen in all cases. The dosage of copper administration in these cases was 0.3 to 7.2 mg of copper/day, or 5.3 to 133 μg of copper/kg/day, with total doses of 7 to 176 mg of copper. (Journal of Parenteral and Enteral Nutrition 13:421-425, 1989)

Get full access to this article

View all access options for this article.

References

Karpel JT , Peden VH : Copper deficiency in long-term parenteral nutrition. Pediatrics 30:32-36, 1972

Josephs HW : Treatment of anemia in infant with iron and copper. Bull Hopkins Hosp 49:246, 1931

Cordano A. , Baerth JM , Graham GG : Cu deficiency in infancy. Pediatrics 34:324, 1964

Danks DM , Campbell PE , Stevens BJ , et al: Menkes' Kinky Hair syndrome: An inherited defect in copper absorption with widespread defects. Pediatrics 50:188-201, 1972

Danks DM , Campbell PE , Walker-Smith, J. , et al: Menkes' Kinky-Hair Syndrome. Lancet 1:1100-1102, 1972

Danks DM , Cartwright E. , Stevens BJ , Townley RRW : Menkes' Kinky Hair Disease: Further definition of the defect in copper transport . Science 179:1140-1142, 1973

Danks DM : Steely hair, mottled mice, and copper metabolism. N Engl J Med 293:1147-1148, 1975

Dunlap WM , Watson James III G. , Hume DM : Anemia and neutropenia caused by copper deficiency. Ann Intern Med 80:470-476, 1974

Vilter RW , Bozian RC , Hess EV , et al: Manifestations of copper deficiency in a patient with systemic sclerosis on intravenous hyperalimentation. N Engl J Med 291:188-191, 1974

10.

Heller RM , Kirchner SG , O'Neill JA , et al: Skeletal changes of copper deficiency in infants receiving prolonged total parenteral nutrition. J Pediatr 92:947-949, 1978

11.

Fujita M. , Itakura T. , Takagi Y. , et al: Copper deficiency during total parenteral nutrition. Trace Metal Metabolism (Jap) 5:27-31, 1978

12.

Fujita M. , Okada A. , Kawashima Y. , et al: Copper deficiency and metabolism during total parenteral nutrition . A.S.P.E.N., Abstract, Fifth Clinical Congress , New Orleans. February 1981

13.

Tokuda Y. , Yokoyama S. , Tsuji M. , et al: Copper deficiency in an infant on prolonged total parenteral nutrition. JPEN 10:242-244, 1986

14.

Osaki S. , Johnson DA , Frieden E. : The possible significance of the ferrous oxidase activity of ceruloplasmin in normal human serum. J Biol Chem 241:2746-2751, 1966

15.

Cordano A. , Placko RP , Graham GG : Hypocupremia and neutropenia in copper deficiency. Blood 28:280-283, 1966