What could be the possible source of copper toxicity in a child?

From the Guidelines

Possible sources of copper ingestion in a child include copper water pipes in older homes, contaminated drinking water, copper cookware, certain multivitamins or mineral supplements, and rarely copper-containing pesticides or fungicides. These sources can lead to copper toxicity, which can cause vomiting, abdominal pain, diarrhea, and in severe cases, liver damage or hemolytic anemia 1. Children with pica (eating non-food items) might consume copper coins or copper-containing objects, increasing their risk of copper poisoning 1. Acute copper poisoning typically occurs when children drink acidic beverages stored in copper containers or when copper sulfate products are accidentally ingested 1. If copper poisoning is suspected, immediate medical attention is necessary, and treatment may include gastric lavage, activated charcoal, and chelation therapy with medications like D-penicillamine or dimercaprol depending on severity 1. Prevention involves proper storage of copper-containing products, using appropriate cookware, and monitoring children to prevent access to copper sources. Children with Wilson's disease, a genetic disorder affecting copper metabolism, require special monitoring and treatment, including zinc therapy to induce enterocyte metallothionein and prevent copper absorption 1. Key points to consider in managing copper ingestion in children include:

• Monitoring for symptoms of copper toxicity
• Providing immediate medical attention if poisoning is suspected
• Using chelation therapy or zinc treatment as needed
• Preventing access to copper sources
• Specialized care for children with Wilson's disease.

From the FDA Drug Label

Treatment has two objectives: (1) to minimize dietary intake of copper; (2) to promote excretion and complex formation (i.e., detoxification) of excess tissue copper. The first objective is attained by a daily diet that contains no more than 1 or 2 mg of copper. Such a diet should exclude, most importantly, chocolate, nuts, shellfish, mushrooms, liver, molasses, broccoli, and cereals and dietary supplements enriched with copper, and be composed to as great an extent as possible of foods with a low copper content Possible sources of copper digestion in a child include:

• Foods with high copper content, such as:
  • Chocolate
  • Nuts
  • Shellfish
  • Mushrooms
  • Liver
  • Molasses
  • Broccoli
  • Cereals and dietary supplements enriched with copper
• Drinking water with high copper levels (more than 0.1 mg/L of copper) 2

From the Research

Possible Sources of Copper Digestion in a Child

• Breast milk is a possible source of copper digestion in a child, as copper is well absorbed from breast milk compared with infant formula 3
• Infant formula can also be a source of copper, but the bioavailability of copper from different infant diets needs to be evaluated further 3
• Dietary factors such as protein sources, amino acids, phytate, ascorbic acid, and other essential cations can affect copper absorption in infants 3
• Copper can be obtained from the diet, but the amount of copper in the diet may not be sufficient to meet the child's needs, especially if the child has a low copper intake or low bioavailability from the diet 3

Factors Affecting Copper Digestion

• Premature infants are prone to develop copper deficiency unless given higher provisions of copper 3
• Copper excess is also a possibility, and there are limited opportunities to diagnose copper toxicity 3
• Homeostatic regulation of copper metabolism in infants needs to be evaluated further 3
• Genetic susceptibility to copper dysregulation can lead to rare occurrences of liver and other organ toxicity with elevated copper exposure 4

Treatment of Copper Deficiency

• Copper deficiency can be treated with intravenous repletion with doses 4-8 times the usual nutrition recommendations 5
• Chelation treatment with penicillamine (PCA) in cross combination with sodium 2,3-dimercapto-1-propane sulfonate (DMPS) can be effective in treating Wilson's disease, a genetic disorder that affects copper metabolism 6
• Other chelators such as trientine and 8-hydroxyquinolines may also be effective in treating copper-related disorders 7