Copper deficiency

Reduced serum copper and caeruloplasmin. In adults, most common causes: bariatric surgery, prolonged high-dose zinc intake, malabsorption after small-bowel resection, parenteral nutrition without copper. Presents with microcytic or normocytic anaemia and neutropenia, copper-deficiency myelopathy with sensory ataxia and paraesthesias, occasionally dementia. Treatment: oral copper 2–8 mg/day or IV copper sulfate in severe deficiency, with review of zinc intake that often triggered it.

ICD-10 E61.01 drug

Also known as: Hypocupraemia, Copper-deficiency anaemia, Menkes disease

Drugs used for this condition

BCopperFirst line · Trace cofactor mineral, used in parenteral nutrition and supplementsCopper preparations are used in confirmed deficiency after bariatric surgery, malabsorption syndromes, prolonged high-dose zinc intake, parenteral nutrition without copper and the rare paediatric Menkes disease. Baseline strategy: oral copper sulfate, gluconate or bisglycinate 2–8 mg elemental copper/day according to severity; in severe neutropenia and myelopathy – IV copper sulfate 1–2 mg/day. The cause must be addressed in parallel: in most adults it is chronic zinc intake above 40 mg/day or zinc-containing denture cream. Targets: normal caeruloplasmin and reversal of neurological symptoms when treatment starts early. Guidance: ESPEN, ASPEN, Kumar 2004 (Neurology).

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit