What is the treatment for copper deficiency?

Treatment of Copper Deficiency

Oral supplementation with 4-8 mg/day of elemental copper is recommended for mild to moderate copper deficiency, while intravenous copper supplementation may be required for severe deficiency. 1

Diagnosis Before Treatment

Before initiating treatment, confirm copper deficiency with:

• Serum copper levels <12 μmol/L with elevated CRP >20 mg/L suggest deficiency
• Levels <8 μmol/L confirm deficiency regardless of CRP 1
• Always check both copper and zinc levels simultaneously, as copper deficiency can mimic myelodysplastic syndrome or vitamin B12 deficiency 1
• Complete blood count to assess for anemia and neutropenia
• Ceruloplasmin levels should be considered

Treatment Protocol

Mild to Moderate Deficiency

• Oral supplementation with 4-8 mg/day of elemental copper 1
• For adults and children age 12+: 10 drops of copper sulfate solution 3-4 times daily 2
• For children ages 2-11: 5 drops of copper sulfate solution 3-4 times daily 2
• For children under age 2: Consult a doctor 2
• Prescribe multivitamin supplements containing copper for 3 months 1

Severe Deficiency

• Intravenous copper supplementation is required 1, 3
• Severe cases may need active intravenous repletion with doses 4-8 times the usual nutrition recommendations 3
• After initial IV repletion, transition to combined IV and oral supplementation, and eventually oral supplements alone 4

Duration and Monitoring

• Recheck copper levels after 3 months of supplementation 1
• Monitor for improvement in hematological parameters and neurological symptoms
• For patients with ongoing risk factors, consider regular monitoring every 6-12 months 1
• Treatment should never be terminated indefinitely in patients with chronic deficiency risk factors 5

Special Considerations

High-Risk Populations

• Patients after bariatric surgery, especially gastric bypass
• Patients with malabsorptive conditions
• History of gastrectomy or small bowel resections
• Patients on prolonged parenteral nutrition without adequate copper
• Patients undergoing continuous renal replacement therapy
• Preterm infants and children with nutritional disorders 1

Zinc Supplementation

• When supplementing both zinc and copper, maintain a ratio of 8-15 mg zinc to 1 mg copper 1
• High-dose zinc can reduce copper absorption, requiring monitoring 1

Dietary Recommendations

• Dietary sources of copper include cereals, fresh fruits, vegetables, fish, and seafood 1
• For patients with Wilson's disease (copper overload), avoid foods with very high copper concentrations (shellfish, nuts, chocolate, mushrooms, organ meats) 5, 1

Expected Outcomes and Prognosis

• Hematological manifestations (anemia, neutropenia) are typically fully reversible with copper supplementation over a 4-12 week period 6
• Neurological manifestations may be only partially reversible, emphasizing the importance of early diagnosis and treatment 7, 3
• Severe copper deficiency left untreated can lead to significant morbidity and mortality, particularly in preterm infants and children 1

Important Caveats

• Neurological symptoms of copper deficiency (myelopathy, peripheral neuropathy, ataxia) may be irreversible if diagnosis and treatment are delayed 7
• Copper deficiency can mimic myelodysplastic syndrome, leading to misdiagnosis and inappropriate treatment 8
• In pregnant women with Wilson's disease, treatment must be maintained throughout pregnancy to prevent fulminant hepatic failure 5

Prompt recognition and appropriate treatment of copper deficiency is essential to prevent irreversible neurological damage and correct hematological abnormalities.