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.

Related Blog Posts:

• Drug Shortages and Selenium Deficiency | gutsandgrowth
• Critical drug shortages in U.S. | gutsandgrowth
• TPN Drug Shortages -A Useful Reference | gutsandgrowth