Recently one of my radiology colleagues, Dr. Laura Hayes, put together (lead author) a presentation (poster) for an upcoming meeting. The main focus of the presentation is a TPN-dependent toddler who presented with refusal to walk due to copper deficiency.
Attached is a link to the presentation: TPN Copper. This link is a power point presentation with numerous radiographs and even bone scan images.
- All TPN components except dextrose have been in periods of shortage over the last few years.
- TPN-dependent patients may not be receiving all the needed components and their physicians may not have been notified of the specific shortage(s).
- Copper deficiency leads to reduced activity of numerous enzymes important for function of bone, blood, skin, nervous system and hair.
- Subperiosteal hemorrhage leads to the periosteal thickening seen in this case and is associated with the bone pain our patient experienced.
- Increased losses of bilious fluid can increase the risk of copper deficiency due to the excretion of copper in bile.
- Other TPN-related deficiencies reviewed include thiamine deficiency (Wernicke’s encephalopathy), Vitamin D deficiency (Rickets), and Vitamin C deficiency (Scurvy).
Another recent case report:
Oestreich AE, Cole CR. Vigorous periosteal reaction secondary to copper deficiency in an infant on total parenteral nutrition. (2013) Pediatr Radiol 43:1411-1413.
Related Blog Posts: