Treatment of Copper Deficiency
Copper deficiency should be treated with oral supplementation of 4-8 mg/day of elemental copper for mild to moderate deficiency, while severe deficiency may require intravenous copper repletion to rapidly correct hematological abnormalities and limit neurological damage. 1
Diagnosis and Assessment
Before initiating treatment, confirm copper deficiency with:
- Serum copper levels: Deficiency likely if <12 μmol/L with elevated CRP >20 mg/L, definite deficiency if <8 μmol/L regardless of CRP 2
- Always check both copper and zinc levels simultaneously 1
- Complete blood count to assess for microcytic anemia and neutropenia
- Consider ceruloplasmin levels
Treatment Algorithm
Mild Copper Deficiency
- Prescribe multivitamin supplements containing copper for 3 months 2, 1
- For adults, oral supplementation with 4-8 mg/day of elemental copper 2, 1
- Recheck copper levels after 3 months of supplementation
Severe Copper Deficiency
- Intravenous copper repletion is indicated for severe deficiency, especially with neurological symptoms or significant hematological abnormalities 3
- IV copper rapidly corrects hematological indices while combined IV and oral supplementation helps normalize serum copper levels 4
- After stabilization, transition to oral maintenance therapy
Special Considerations
- When supplementing both zinc and copper, maintain a ratio of 8-15 mg zinc to 1 mg copper 2
- If both zinc and copper are low, consider prescribing two Forceval daily for 3 months and recheck levels 2
- For severe copper deficiency, refer for specialist advice 2
Monitoring and Follow-up
- Recheck copper levels after 3 months of supplementation
- Monitor for improvement in hematological parameters (anemia, neutropenia)
- Assess neurological symptoms for improvement
- For patients with ongoing risk factors, consider regular monitoring every 6-12 months
Important Clinical Pearls
- Neurological manifestations of copper deficiency may be irreversible if diagnosis and treatment are delayed, emphasizing the importance of early diagnosis and treatment 1
- Hematological manifestations are typically fully reversible with copper supplementation over a 4-12 week period, while neurological manifestations may only be partially reversible 5
- High-dose zinc supplementation can induce copper deficiency by blocking intestinal absorption of copper 6
- Copper deficiency can mimic myelodysplastic syndrome or vitamin B12 deficiency, leading to misdiagnosis 1, 7
Dietary Considerations
- Dietary sources of copper include cereals, fresh fruits, vegetables, fish, and seafood 2
- Patients should avoid foods with very high concentrations of copper (shellfish, nuts, chocolate, mushrooms, and organ meats) if they have Wilson's disease 2
- For patients with malabsorption, oral supplementation may be insufficient, and IV repletion may be necessary 3
Remember that copper deficiency is more common than previously recognized, particularly in patients after bariatric surgery, with malabsorptive conditions, history of gastrectomy, prolonged parenteral nutrition without adequate copper, or undergoing continuous renal replacement therapy 1, 3.