Tag Archives: copper deficiency

Too Much Zinc

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An interesting case report (DL Saly et al. NEJM 2017; 377: 1379-85) describes a 61 year old woman with multiple medical problems who developed numbness and tingling in hands/feed which progressed to unsteady gait and inability to stand.

Her medical problems included end-stage renal disease requiring dialysis, COPD, hepatitis C, depression,reflux, breast cancer, hypertension, and chronic back pain. Due to dysgeusia and suspected zinc deficiency associated with dialysis, she had been started on zinc therapy and this was doubled when she did not improve.

Ultimately she was diagnosed with copper deficiency which can result from zinc toxicity, “because zinc upregulates the protein to which copper binds in enterocytes, and an excess of zinc forces copper to be trapped in the enterocyte and unavailable for absorption.”

My take: Too much zinc (as well as other micronutrients/vitamins) can result in adverse effects.

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Missing ingredients in TPN -Case Report

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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.

Key points:

  • 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.

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