What is the treatment for copper overdose?

Treatment for Copper Overdose

The first-line treatment for acute copper overdose is chelation therapy with either D-penicillamine or trientine, along with supportive measures including gastric lavage, fluid replacement, and management of complications. 1

Initial Management

• Immediate interventions:

  • Gastric lavage (if presentation is within 1 hour of ingestion)
  • Activated charcoal administration
  • Intravenous fluid resuscitation to address dehydration
  • Monitoring of vital signs and organ function

• Laboratory assessment:

  • Serum copper levels
  • Complete blood count (to assess for hemolysis)
  • Liver function tests
  • Renal function tests
  • Methemoglobin levels (if cyanosis present)

Specific Treatments

Chelation Therapy

1. D-penicillamine

   • Dosage: 750-1500 mg/day in 2-3 divided doses 1, 2
   • Administration: On empty stomach, at least 1 hour before or 2 hours after meals
   • Monitoring: 24-hour urinary copper excretion (target: 200-500 μg/day)
   • Side effects: Hypersensitivity reactions, bone marrow suppression, proteinuria, autoimmune disorders

2. Trientine (triethylene tetramine dihydrochloride)

   • Dosage: 750-1500 mg/day in 2-3 divided doses 1
   • Administration: On empty stomach, 1 hour before or 2 hours after meals
   • Monitoring: Same as D-penicillamine
   • Advantages: Fewer hypersensitivity reactions than D-penicillamine

3. 2,3-dimercaptopropane-1-sulphonate (DMPS)

   • Used in severe acute poisoning cases 3
   • Particularly effective for acute copper sulfate poisoning

Supportive Treatments

• For methemoglobinemia:

  • Methylene blue (1-2 mg/kg IV) 3

• For hemolysis:

  • Blood transfusions as needed
  • Monitoring of hemoglobin and hematocrit

• For hepatic failure:

  • Liver function monitoring
  • Management of coagulopathy
  • Consider N-acetylcysteine in severe cases

• For renal failure:

  • Hemodialysis may be required in severe cases 3
  • Monitor fluid balance and electrolytes

• For adrenal insufficiency:

  • IV hydrocortisone may be necessary 3

Maintenance Therapy

• Zinc therapy:
  • Mechanism: Interferes with intestinal copper absorption by inducing metallothionein
  • Dosage: 150 mg/day in three divided doses 1
  • Monitoring: 24-hour urinary copper excretion (target: <75 μg/day)
  • Particularly useful for maintenance after acute phase is controlled

Dietary Management

• Avoid copper-rich foods during recovery:

  • Shellfish, nuts, chocolate, mushrooms, organ meats 1
  • Use distilled or demineralized water if drinking water contains >0.1 mg/L copper

• Consult with dietitian for comprehensive dietary planning, especially important for vegetarians 1

Special Considerations

• Pregnancy: Treatment must be maintained throughout pregnancy to prevent fulminant hepatic failure 4

• Chronic exposure: May require longer treatment course and monitoring for cirrhosis 5

• Monitoring parameters:

  • Non-ceruloplasmin bound copper (target: <10 μg/dL) 4
  • Values <5 μg/dL suggest overtreatment 4

Pitfalls and Caveats

1. Do not discontinue chelation therapy if neurological symptoms worsen initially, as temporary interruption increases risk of sensitivity reactions upon resumption 2

2. Avoid iron supplementation with trientine as the complex is toxic 1

3. Monitor for copper deficiency with prolonged treatment (signs: pancytopenia, sideroblastic anemia) 1

4. Storage considerations: Trientine tablets are not stable at high temperatures 1

5. Antioxidant supplementation: Consider vitamin E as adjunctive treatment 1

The treatment approach should be tailored based on the severity of poisoning, with acute severe cases requiring aggressive chelation therapy and supportive care, while chronic cases may be managed with lower doses of chelating agents and dietary modifications.