From the Guidelines
Copper deficiency should be treated with copper supplementation, typically with oral copper gluconate or copper sulfate at doses of 2-4 mg elemental copper daily until levels normalize, then 1-2 mg daily for maintenance, as recommended by the most recent guidelines 1. To manage copper deficiency, it is essential to understand the condition, which occurs when the body lacks adequate copper, an essential trace mineral needed for various bodily functions.
Key Considerations
- Copper deficiency can cause anemia, neutropenia, bone abnormalities, and neurological symptoms similar to vitamin B12 deficiency.
- It commonly occurs in patients with malabsorption conditions, after gastric bypass surgery, with excessive zinc supplementation, or prolonged parenteral nutrition without adequate copper.
- Regular monitoring of copper levels during treatment is essential, as excessive copper can be toxic.
- Symptoms typically improve within weeks of starting supplementation, though neurological symptoms may take longer to resolve or could be permanent if treatment is delayed.
Treatment and Prevention
- Patients should consume copper-rich foods like shellfish, nuts, seeds, whole grains, and organ meats.
- For severe deficiency, intravenous copper may be necessary, with a suggested dose of about 3 mg/d of copper to prevent deficiencies 1.
- In patients on long-term parenteral nutrition, plasma Cu and ceruloplasmin should be monitored, especially if they develop PN-associated liver disease or have high gastrointestinal fluid losses 1.
Special Considerations
- In critically ill patients, particularly those on continuous kidney replacement therapy (CKRT), copper losses can be significant, and supplementation may be necessary to prevent deficiency 1.
- The optimal dose of copper supplementation remains unknown, but it is crucial to balance the risks of deficiency and toxicity.
Monitoring and Maintenance
- Copper status should be monitored through plasma concentrations of copper and ceruloplasmin, as well as Cu-Zn superoxide dismutase (SOD) activity in erythrocytes, which seems to be a more sensitive indicator of copper deficiency than plasma concentration of copper or ceruloplasmin 1.
- Neutrophil count, SOD activity, platelet cytochrome-c oxidase activity, and platelet copper concentration are other indicators of copper status 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Copper Deficiency Overview
- Copper is a crucial micronutrient needed by animals and humans for proper organ function and metabolic processes 2
- Copper deficiency can be caused by hereditary or acquired factors, and its prevalence has increased over the past decades 2, 3
- The condition affects various physiologic systems, including bone marrow hematopoiesis, optic nerve function, and the nervous system 2
Clinical Manifestations
- Copper deficiency can lead to nonspecific clinical manifestations, affecting all organs and systems, particularly the hematologic and neurologic systems 3
- Severe copper deficiency can cause devastating individual consequences, including anemia, myeloneuropathy, and cardiovascular, cutaneous, and immune system disorders 3
- Neurological manifestations are only partially reversible with copper supplementation, while hematological manifestations are fully reversible over a 4- to 12-week period 2
Diagnosis and Treatment
- Diagnosis of copper deficiency is made by measuring serum copper, serum ceruloplasmin, and 24-h urine copper levels 2
- Treatment involves oral or intravenous copper replacement in the form of copper gluconate, copper sulfate, or copper chloride 2
- Patients with severe copper deficiency may require active intravenous repletion with doses 4-8 times the usual nutrition recommendations 3
Associations with Other Conditions
- Copper deficiency has been associated with celiac disease, with patients presenting with neurologic complications and hematologic abnormalities 4
- It has also been linked to Crohn's disease, particularly in patients receiving parenteral nutrition 5
- Disruption of copper homeostasis may underlie the development of various diseases, including ischemic heart disease, connective tissue and neurodegenerative disorders, and non-alcoholic fatty liver disease (NAFLD) 6