Zinc in denture adhesive: a rare cause of copper deficiency in a patient on home parenteral nutrition

Prasad, Rajendra; Hawthorne, Barney; Durai, Dharmaraj; McDowell, I.F.W.

doi:10.1136/bcr-2015-211390

Cited by 8 publications

(6 citation statements)

References 7 publications

(9 reference statements)

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“…High-iron feeding of rapidly growing rats thus causes CDA. Precedence for such mineral interactions has been established, as, for example, high zinc intake induces severe copper deficiency in humans [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats

Doguer

Wang

et al. 2016

PLoS ONE

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Iron-copper interactions were described decades ago; however, molecular mechanisms linking the two essential minerals remain largely undefined. Investigations in humans and other mammals noted that copper levels increase in the intestinal mucosa, liver and blood during iron deficiency, tissues all important for iron homeostasis. The current study was undertaken to test the hypothesis that dietary copper influences iron homeostasis during iron deficiency and iron overload. We thus fed weanling, male Sprague-Dawley rats (n = 6-11/group) AIN-93G-based diets containing high (~8800 ppm), adequate (~80) or low (~11) iron in combination with high (~183), adequate (~8) or low (~0.9) copper for 5 weeks. Subsequently, the iron- and copper-related phenotype of the rats was assessed. Rats fed the low-iron diets grew slower than controls, with changes in dietary copper not further influencing growth. Unexpectedly, however, high-iron (HFe) feeding also impaired growth. Furthermore, consumption of the HFe diet caused cardiac hypertrophy, anemia, low serum and tissue copper levels and decreased circulating ceruloplasmin activity. Intriguingly, these physiologic perturbations were prevented by adding extra copper to the HFe diet. Furthermore, higher copper levels in the HFe diet increased serum nonheme iron concentration and transferrin saturation, exacerbated hepatic nonheme iron loading and attenuated splenic nonheme iron accumulation. Moreover, serum erythropoietin levels, and splenic erythroferrone and hepatic hepcidin mRNA levels were altered by the dietary treatments in unanticipated ways, providing insight into how iron and copper influence expression of these hormones. We conclude that high-iron feeding of weanling rats causes systemic copper deficiency, and further, that copper influences the iron-overload phenotype.

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Section: Discussionmentioning

confidence: 99%

High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats

Doguer

Wang

et al. 2016

PLoS ONE

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“…A study by Sutton et al [361] showed that cytopenia in patients can be caused by a high Zn concentration in the body combined with Cu deficiency, and Cu supplementation leads to a reversal of hematologic levels. According to Prasad et al [362], increased Zn concentration may be caused by improperly fitting dentures, resulting in increased use of dental adhesive, which contains high levels of Zn. Excess Cu can lead to both anemia and neutropenia as a result of the mechanisms in which Cu participates.…”

Section: Cu Vs Znmentioning

confidence: 99%

The Role of Fe, Zn, and Cu in Pregnancy

2020

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Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.

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“…For patients treated with PN, the source of excess Zn may not necessarily be parenteral. For example, excessive intake of Zn from a denture adhesive was recently reported to cause ZICD for a patient on long‐term PN containing standard Cu provision 39 . The patient presented with mild pancytopenia and perioral paraesthesia, which did not respond to additional Cu provision but resolved after the adhesive was switched to a Zn‐free product.…”

Section: Cu Deficiencymentioning

confidence: 99%

Review of Copper Provision in the Parenteral Nutrition of Adults

Livingstone

2016

Nut in Clin Prac

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ReviewCopper (Cu) is an essential trace element (TE) required for metabolism in all living cells. It has been known to be an essential component of parenteral nutrition (PN) since 1972.1 Provision of the correct amount of Cu is necessary, not only to avoid deficiency and toxicity, but also to promote optimal recovery.2 This article covers the relevant physiology of Cu. It then discusses Cu deficiency and toxicity and examines the evidence behind the recommendations on Cu provision in PN. It provides practical guidance on assessment of Cu status and Cu requirements. The article focuses on adults because provision of Cu in pediatric PN has recently been covered elsewhere, 3 but pediatric studies have been cited where considered appropriate. PhysiologyCu is among the 3 most abundant transition metals in biological systems, the other 2 being iron (Fe) and zinc (Zn). The human body contains around 100 mg of Cu, more than half of which is in bone and muscle. The highest concentrations are in liver, kidney, and brain, reflecting the high metabolic activity of these organs.2 Only 5% is in blood, about 95% of this being bound to ceruloplasmin (Cp) and the remainder to albumin and amino acids. 4 The serum Cu concentration therefore largely reflects the Cp concentration and is affected by factors influencing Cp. Intracellular Cu is usually bound to chaperones and other proteins because free Cu is potentially harmful to cells.Cu, which functions as a component of cuproproteins, has a variety of physiologic roles. For example, it is required for humoral immunity and production of inflammatory cytokines. 5,6 It was recently suggested that the immune system uses Cu intoxication as a means of intracellular bacterial killing. 7,8 Cu is required for the physiologic response to low Fe stores. It is needed for absorption of dietary Fe, release of Fe from hepatocytes and production of hemoglobin.9 Cp oxidizes Fe from the ferrous to ferric state, enabling its transport by transferrin and subsequent use in erythropoiesis. Superoxide dismutase is an antioxidant cuproenzyme that catalyzes the conversion of superoxide radicals to hydrogen peroxide, which is then reduced to water.10 Cu is also necessary for wound healing because it is required for the synthesis of collagen.The average daily oral intake of Cu is 1.0-1.6 mg, which exceeds the RDA of 0.9 mg.11 Dietary Cu is absorbed mainly in the stomach and upper small intestine.2,12 About 55%-75% of dietary Cu is absorbed, which is a high proportion as compared AbstractThe essential trace element copper (Cu) is required for a range of physiologic processes, including wound healing and functioning of the immune system. The correct amount of Cu must be provided in parenteral nutrition (PN) if deficiency and toxicity are to be avoided. While provision in line with the standard recommendations should suffice for most patients, Cu requirements may be higher in patients with increased gastrointestinal losses and severe burns and lower in those with cholestasis. The tests of Cu status that are c...

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Zinc in denture adhesive: a rare cause of copper deficiency in a patient on home parenteral nutrition

Cited by 8 publications

References 7 publications

High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats

High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats

The Role of Fe, Zn, and Cu in Pregnancy

Review of Copper Provision in the Parenteral Nutrition of Adults

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