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Copper - Disorders of Nutrition - Merck Manuals Consumer Version

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Copper
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Copper ˈkäp-ər

By Larry E. Johnson, MD, PhD, Associate Professor of Geriatrics and Family and Preventive Medicine, University of Arkansas for Medical Sciences; Medical Director, Central Arkansas Veterans Healthcare System

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version

Most of the copper in the body is located in the liver, bones, and muscle, but traces of copper occur in all tissues of the body. The liver excretes excess copper into the bile for elimination from the body. Copper is a component of many enzymes, including ones that are necessary for the following:

  • Energy production

  • Formation of red blood cells, bone, or connective tissue (which binds other tissues and organs together)

  • Antioxidant action (to help protect cells against damage by free radicals, which are reactive by-products of normal cell activity)

Copper deficiency may be acquired or inherited.

Copper excess (toxicity) may also be acquired or inherited (as Wilson disease).

(See also Overview of Minerals.)

Copper Deficiency

Copper deficiency is rare among healthy people. It occurs most commonly among infants who are

  • Premature

  • Recovering from severe undernutrition

  • Having persistent diarrhea

Some male infants inherit a genetic abnormality that causes copper deficiency. This disorder is called Menkes syndrome.

In adults, copper deficiency may be caused by

  • Disorders that impair absorption of nutrients (malabsorption disorders, such as celiac disease, Crohn disease, cystic fibrosis, or tropical sprue)

  • Weight-loss (bariatric) surgery

  • Consumption of too much zinc, which reduces the absorption of copper

(See also Wilson Disease.)

Symptoms

Symptoms of copper deficiency include fatigue, anemia, and a decreased number of white blood cells. Sometimes, osteoporosis develops or nerves are damaged. Nerve damage can cause tingling and loss of sensation in the feet and hands. Muscles may feel weak. Some people become confused, irritable, and mildly depressed. Coordination is impaired.

Menkes syndrome causes severe intellectual disability, vomiting, and diarrhea. The skin lacks pigment, and the hair is sparse, steely, or kinky. Bones may be weak and malformed, and arteries are fragile, sometimes rupturing.

Diagnosis

  • A doctor's evaluation

  • Blood tests

Copper deficiency is usually diagnosed based on symptoms and on blood tests that detect low levels of copper and ceruloplasmin (a copper-carrying protein).

Early diagnosis and treatment of copper deficiency seem to result in a better outcome.

Treatment

  • Treatment of the cause

  • A copper supplement or injection

The cause is treated, and a copper supplement is given by mouth.

For infants with Menkes syndrome, copper is injected under the skin (subcutaneously). Despite treatment, children with Menkes syndrome usually die before they are 10 years old.

Copper Excess

Consumption of excess copper is rare. People may consume small amounts of excess copper in acidic food or beverages that have been in copper vessels, tubing, or valves a long time.

Consuming even relatively small amounts of copper may cause nausea, vomiting, and diarrhea. Large amounts, usually consumed by people intending to commit suicide, can damage the kidneys, inhibit urine production, and cause anemia due to the rupture of red blood cells (hemolytic anemia) and even death.

Rarely, liver damage or cirrhosis occurs in children. It probably results from drinking milk that has been boiled or stored in corroded copper or brass vessels.

Diagnosis

  • Blood or urine tests

  • A liver biopsy

Doctors measure copper and ceruloplasmin levels in blood or urine. However, a liver biopsy is usually required for diagnosis unless large amounts of copper were consumed.

Treatment

  • Pumping the stomach

  • Dimercaprol injected into a muscle

  • Penicillamine

  • Hemodialysis

If large amounts of copper were consumed, the stomach is pumped.

If copper toxicity has caused problems such as anemia or has damaged the kidneys or liver, dimercaprol is injected into a muscle, or a drug that binds with copper, such as penicillamine, is given to remove excess copper. Children with liver damage are treated with penicillamine.

If used early, hemodialysis (a procedure that filters the blood) may be effective.

Occasionally, death occurs despite treatment.

Last full review/revision November 2018 by Larry E. Johnson, MD, PhD

Drugs Mentioned In This Article

  • Generic Name Select Brand Names
  • Penicillamine CUPRIMINE
  • Dimercaprol BAL
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In addition to its important role in formation, growth, and repair of bone, skin and connective tissue, vitamin C also protects the body's cells against which of the following?

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