In reply to Nick Miller's comments, I must make a further comment on the
causes of low copper in burns. It would appear from the recent work of
Berger et al (ie Burns, 1992, 18:373) and the earlier work of others that
substantial loss of trace elements can occur cutaneously in burned
patients, resulting in concentrattions associated with copper deficiency.
It is probable that for most plastic surgeons keeping the sevrely burned
patient alive is of considerably more importance, and not much attention is
paid to details like trace element status!!
In the burned patient, and in other patients on TPN, the acute phase
response is more likely to increase substantially the copper and
caeruloplasmin concentrations and decrease the zinc concentrations, so low
copper concentrations are a true sign of deficiency. Liver zinc
concentration is increased, so there is unlikely to be insufficient zinc
available for protein synthesis.
The greater danger from zinc is oral supplementation, which can reduce
copper absorption and thus cause copper deficiency. I have seen a few
cases of low coppers which may have been due to excessive zinc intake.
Barry Sampson
Barry Sampson
Trace Element Laboratory
Clinical Chemistry
Charing Cross Hospital
London W6 8RF
UK
Phone +44-181-846-7080
Fax +44-181-846-7007
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