Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation

Rowin, Julie; Lewis, Steven L.

doi:10.1136/jnnp.2004.046987

Cited by 100 publications

(65 citation statements)

References 19 publications

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“…1). 1,11 Zinc excess can occur with parenteral feeding, 1 use of supplements 6,11 and accidental ingestion of zinc-containing denture adhesive. 1,2 Our patient reported using dentures for the past seven to eight years and in the past four years had noticed a deterioration in the fit of the dentures.…”

Section: How Does Zinc Excess Results In Copper Deficiency?mentioning

confidence: 99%

Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy

2011

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Section: How Does Zinc Excess Results In Copper Deficiency?mentioning

confidence: 99%

Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy

2011

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“…Excess zinc increases the production of metallothionein, a heavy metal binding protein, by enterocytes. Copper binds with high affinity to metallothionein within the enterocytes leading to its excretion through the intestinal tract [12]. Myeloneuropathy due to copper deficiency has been reported following treatment of Wilson disease with chelation and zinc [13–15].…”

Section: Discussionmentioning

confidence: 99%

Copper deficiency, a new triad: anemia, leucopenia, and myeloneuropathy

Wazir

Ghobrial

2017

Journal of Community Hospital Internal Medicine Perspectives

100

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Clinical copper deficiency is now more frequently recognized. Hematologically, it can present as anemia (microcytic, normocytic, or macrocytic) and neutropenia. Thrombocytopenia is relatively rare. Neurologically, it can manifest as myelopathy and peripheral neuropathy simulating subacute combined degeneration. Bone marrow findings can mimic myelodysplasia resulting in occasional inappropriate referral for bone marrow transplantation. Other conditions with similar presentations include infections, drug toxicity, autoimmunity, B12 deficiency, folate deficiency, myelodysplastic syndrome, aplastic anemia, and lymphoma with bone marrow involvement. Hematological, but not neurological, manifestations respond promptly to copper replacement, making early diagnosis essential for good outcome. Common risk factors for copper deficiency are foregut surgery, dietary deficiency, enteropathies with malabsorption, and prolonged intravenous nutrition (total parenteral nutrition). We present a unique case of copper deficiency, with no apparent known risk factors.

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“…15 Copper deficiency can be observed in patients submitted to a zinc rich diet. 7 When copper deficiency occurs, there are failures in collagen and elastin reticulation and problems with tissue plasticity and solidity, particularly in arteries. 7 Its excess can cause diarrhea, nausea, vomiting, cirrhosis, anemia and bronchitis.…”

Section: Introductionmentioning

confidence: 99%

“…6 Minerals are micronutrients with an important role in childhood growth and development. 7 Iron, copper and zinc are necessary in daily amounts much lower than 100 mg, Vol. 20, No.…”

Section: Introductionmentioning

confidence: 99%

“…7 When copper deficiency occurs, there are failures in collagen and elastin reticulation and problems with tissue plasticity and solidity, particularly in arteries. 7 Its excess can cause diarrhea, nausea, vomiting, cirrhosis, anemia and bronchitis. 13 However, even though many of these trace elements functions are well known, and even though good infant growth has been attained using milk formulas and powdered milk in infant feeding, there is not many data relative to the amounts of these elements in these products available in the Brazilian market, in order to compare them with infant nutritional requirements.…”

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Iron, copper and zinc in substitute foods for maternal milk: comparison with infant nutritional requirements

Moraes

Feijo

Melo

et al. 2009

J. Braz. Chem. Soc.

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Este estudo objetivou investigar os teores de ferro, cobre e zinco de fórmulas infantis para lactentes e leites em pó, disponíveis no mercado, realizando uma análise comparativa entre os teores encontrados, a ingestão diária recomendada (IDR) e a ingestão diária máxima tolerável (IDMT). A determinação dos elementos traço foi realizada por espectrofotometria de absorção atômica. Os teores de ferro, cobre e zinco variaram em uma ampla faixa, dependendo do produto, apresentando-se algumas vezes abaixo da IDR (ferro) e outras acima (zinco), ultrapassando o IDMT, o que compromete o uso confiável destes alimentos a longo prazo, principalmente em dietas monótonas.This study aimed to investigate iron, copper and zinc contents in baby formulas for lactents and powdered milk, conducting a comparative analysis between the observed values, the dietary reference intake (DRI) and the tolerable upper intake level (UL). The determination of these trace elements was performed by atomic absorption spectrometry. Iron, copper and zinc values varied in a wide concentration range, depending on the product. They were sometimes below the DRI (iron) and sometimes above it (zinc), surpassing the UL, compromising the reliable use of these food products in the long run, especially in monotonous diets.Keywords: trace elements, baby formulas for lactents, powdered milk, infant requirements, atomic spectrometry IntroductionExclusive maternal feeding until the child is six months old, and from then on, the inclusion of complementary foods in the child's diet available in the family unit is the procedure recommended by the World Health Organization (WHO) for children worldwide. 1 This recommendation is based on the knowledge that, until the child is six months old, exclusive feeding on maternal milk is enough to satisfy the child's nutritional requirements, besides favoring protection against diseases. 2 After this age, the inclusion of complementary foods in the child's feeding schedule aims, mainly, to elevate energy and micronutrient quotas, maintaining breast feeding until the child is 12 or 24 months old. [1][2][3] There is evidence that weaning is intense and occurs very precociously. 4 The introduction of complementary food ingestion happens very early in the child's life, and these foods are offered in insufficient quantities to reach nutritional requirements, especially micronutrient requirements. 1 Studies point out that the early offer of milks and baby formulas for lactents are predictors of early weaning. 2 Inadequate complementary food is a major cause of the high prevalence of malnutrition in the developing world. 5 It is observed that, although greater intakes of complementary foods are associated with higher total energy intake, micronutrient intake remains low due to the low micronutrient concentration of these complementary foods. 6 Minerals are micronutrients with an important role in childhood growth and development. 7 Iron, copper and zinc are necessary in daily amounts much lower than 100 mg, Moraes et al. 1725 Vol. 20...

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Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation

Cited by 100 publications

References 19 publications

Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy

Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy

Copper deficiency, a new triad: anemia, leucopenia, and myeloneuropathy

Iron, copper and zinc in substitute foods for maternal milk: comparison with infant nutritional requirements

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