Intravenous nutrition copper

Drs. Filer and Muller, at the University of Iowa, treated an 8 year old girl with total parenteral nutrition for three two-month periods because of a poorly mobile gastrointestinal tract. Each period of treatment was separated by 5 months of oral alimentation. Following the last period of total intravenous nutrition, the same solution was administered via jejunostomy for an additional month. At that time, plasma and hair measurements were made. Table 5 shows that zinc and copper concentrations were significantly low in both plasma and hair. The chromium and manganese concentrations, however, remained in the normal range. 

Copper deficiency has been reported in a patient with Crohn s disease after removal of copper from the parenteral nutrition because of severe cholestasis (59). The patient developed pancytopenia with severely depressed serum copper concentrations after 8 weeks. Bone-marrow biopsy confirmed the cause as copper deficiency. Although intravenous replacement of copper improved the patient s anemia and other markers, he suddenly died of cardiac tamponade. 

Nutritional Support. Adults and children fed intravenously without addition of sufficient copper to the nutrient regimen develop symptomatic copper deficiency. The hematological changes of hypochromic anemia and neutropenia are reversed by copper supplementation. Similar effects have been reported during prolonged enteral feeding via jejunostomy. Children may also develop the typical bone changes mentioned above. 

Plate 8 Total parental nutrition wherein up to three litres of a colloidal emulsion is administered intravenously per patient per day. Trace elements which are necessary for long-term TPjN include calcium, magnesium, iron, copper, zinc, cobalt, manganese, selenium, chromium, molybdenum, iodine, fluorine, phosphorus, chlorine, sodium, and potassium. Photograph provided by Kabi Pharmacia... 

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