Dear Tim,
You may find this recent article useful.
Muller T, Koppikar S, Taylor RM, Carragher F, Schlenck B, Heinz-Erian
P, Kronenberg F, Ferenci P, Tanner S, Siebert U, Staudinger R, Mieli-Vergani
G, Dhawan A.
Related Articles, Links
Re-evaluation of the penicillamine challenge test in the diagnosis of
Wilson's disease in children.
J Hepatol. 2007 Aug;47(2):270-6. Epub 2007 Apr 4.
PMID: 17449133 [PubMed - indexed for MEDLINE]
Best regards,
Chloe
**************************
Dr Chloe Mak
Chemical Pathologist
MBBS, FRCPA, FHKAM
Division of Clinical Biochemistry
Queen Mary Hospital
Hong Kong
----- Original Message -----
From: "Nick Miller" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, October 18, 2007 9:16 PM
Subject: Re: Penicillamine challenge in Wilson's disease
> Tim,
>
> I don't often do penicillamine challenge tests as it is a poorly
> tolerated chelating agent, especially in children.
>
> When we do, the protocol is to do 2 baseline measurements of 24h
> urinary copper before starting the test, then at 9.00 am on the day of
> the test give 500 mg of penicillamine, take blood for copper and
> caeruloplasmin, and start a new 24 hour urine copper collection.. A
> second dose of 500 mg of penicillamine is given at 9.00 pm at night
> and the urine collection for copper terminated at 9.00 am the next
> morning. This makes it an in-patient procedure, but if the patient is
> going home I would accept the second dose of penicillamine at 6.00 pm.
>
> The interpretation is a that in Wilson's you expect a serum copper of
> less than 12 mmol/L with an inappropriately low or undetectable
> caeruloplasmin and an incremental excretion of urine copper of greater
> than 20 mmol/L.
>
>
> Reference: da Costa DM, Baldwin D, Portmann B, Lolin Y, Mowat A,
> Mieli-Vergani G. Value of urinary copper excretion after penicillamine
> challenge in the diagnosis of Wilson's disease. Hepatology
> 1992;15:609-615
>
> Glad to see you are using dynamic testing to make your diagnoses of
> metal toxicity!
>
> Nick Miller
> London
>
> On 18/10/2007, Reynolds Tim <[log in to unmask]> wrote:
>> I need to organise a penicillamine challenge test for a patient with
>> probable Wilson's disease there are lots of references to this test on
>> the net but they all give instructions like this:
>>
>> Following penicillamine 0.5 g 12 hourly x 2, urine copper exceeds 25
>> micromol/24 hour in 88% patients with WD and 2% with other liver
>> disorders.
>>
>> Does anyone know the precise time schedule relating the penicillamine
>> should be taken and the time the urine collection starts?
>>
>> i.e. is it start both penicillamine and collection at the same time, or
>> is there a lag between taking the drug and starting th eurine
>> collection?
>>
>> TIM
>>
>> ************************************************************************
>> *************
>> Prof. Tim Reynolds,
>> Queen's Hospital,
>> Belvedere Rd,
>> Burton-on-Trent,
>> Staffordshire,
>> DE13 0RB
>>
>> work tel: 01283 511511 ext. 4035
>> work fax: 01283 593064
>> work email: [log in to unmask]
>> home email: [log in to unmask]
>> ************************************************************************
>> **************
>> IMPORTANT: This email is intended for the use of the individual
>> addressee(s)named above and may contain information that is confidential
>> privileged or unsuitable for overly sensitive persons with low
>> self-esteem, no sense of humour or irrational religious beliefs [if you
>> want to believe in fairy stories and hug pixies that's up to you]. If
>> you are not the intended recipient, any dissemination, distribution or
>> copying of this email is not authorized (either explicitly or
>> implicitly) and constitutes an irritating social faux pas. Unless the
>> word absquatulation has been used in its correct context somewhere other
>> than in this warning, it does not have any legal or grammatical use and
>> may be ignored. No animals were harmed in the transmission of this
>> email, though the kelpie next door is living on borrowed time, let me
>> tell you. Those of you with an overwhelming fear of the unknown will be
>> gratified to learn there is no hidden message revealed by reading this
>> backwards, so just ignore that Alert Notice from Macroshaft. However, by
>> pouring a complete circle of salt around yourself and your computer you
>> can ensure that no harm befalls you and your pets. If you have received
>> this eMail in error, please add some nutmeg and egg whites, whisk, and
>> place in a warm oven for 40 minutes.
>>
>> ------ACB discussion List Information--------
>> This is an open discussion list for the academic and clinical
>> community working in clinical biochemistry.
>> Please note, archived messages are public and can be viewed
>> via the internet. Views expressed are those of the individual and
>> they are responsible for all message content.
>> ACB Web Site
>> http://www.acb.org.uk
>> List Archives
>> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
>> List Instructions (How to leave etc.)
>> http://www.jiscmail.ac.uk/
>>
>
> ------ACB discussion List Information--------
> This is an open discussion list for the academic and clinical
> community working in clinical biochemistry.
> Please note, archived messages are public and can be viewed
> via the internet. Views expressed are those of the individual and
> they are responsible for all message content.
> ACB Web Site
> http://www.acb.org.uk
> List Archives
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> List Instructions (How to leave etc.)
> http://www.jiscmail.ac.uk/
>
***************************************************************************
Disclaimer
This Email may contain privileged and confidential information and is solely for the use of the intended recipient. If you are not the intended recipient, you must not print, copy, distribute or take any action in reliance on it. If you have received this Email by mistake, please notify the sender and then delete this Email from your computer. The Hospital Authority does not accept liability arising from Email transmitted by mistake.
Although this Email and any attachments are believed to be free of virus or other defects that might affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free, and no responsibility is accepted by the Hospital Authority for any loss or damage in any way arising from its use.
All views or opinions expressed in this Email and its attachments are those of the sender and do not necessarily reflect the views and opinions of the Hospital Authority.
***************************************************************************
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
