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Copper deficiency
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Copper deficiency

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Contributors: Michael W. Winter MD, Paritosh Prasad MD
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Synopsis

Copper deficiency (hypocupremia) is an abnormally low level of copper, a trace mineral. In the United States, most copper is ingested from vegetable sources, legumes, and grains, although meat, fish, and poultry are also sources of dietary copper. Copper deficiency is usually due to decreased absorption (ie, severe malabsorptive diarrhea), or it results from excess ingestion of zinc, ascorbic acid, or iron, which can chelate copper. Copper is solubilized via interaction with gastric acid and then absorbed through the proximal small bowel. It is stored in the liver. Due to its widespread availability in food sources and the body's ability to maintain long-term copper storage, deficiency from decreased dietary ingestion is quite uncommon in the United States.

Copper is an important mineral in antioxidant activity, bone formation, melanin production, coagulation, and neurotransmitter synthesis. Its varied role highlights the varied phenotype of copper deficiency. Patients who are deficient in copper can present with abnormal fragile hair, ataxia, decreased skin pigmentation, muscle weakness, neuropathy, bleeding disorders, anemia, and neutropenia. Blood work may reveal microcytic anemia and, in some cases, neutropenia.

Patients who have undergone gastric surgery (either gastrectomy or gastric bypass) are at risk for copper deficiency, as they may insufficiently mobilize copper from food sources due to limited acid exposure. Patients with small bowel malabsorption such as small bowel Crohn disease, celiac disease, or protein-losing enteropathies are also at an increased risk. Other populations in which to consider copper deficiency are chronic dialysis patients, premature infants on supplementary formula with no added copper, and patients taking excess zinc or chelating agents that may decrease copper's bioavailability.

See Menkes kinky hair syndrome for discussion of inherited copper deficiency.

Codes

ICD10CM:
E61.0 – Copper deficiency

SNOMEDCT:
19577007 – Hypocupremia

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Last Reviewed: 10/22/2018
Last Updated: 10/22/2018
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Copper deficiency
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Copper deficiency : Hepatomegaly, Ataxia, Muscle weakness, Serum ceruloplasmin low, Splenomegaly, Generalized edema, WBC decreased, RBC decreased, Urine copper decreased
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