Merck Manual

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Copper Deficiency

By

Larry E. Johnson

, MD, PhD, University of Arkansas for Medical Sciences

Last full review/revision Jun 2020| Content last modified Jun 2020
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Copper deficiency is rare among healthy people and occurs most commonly among infants who have other health problems or inherit a genetic abnormality.

Most of the copper in the body is located in the liver, bones, and muscle, but traces of copper occur in all tissues of the body. The liver excretes excess copper into the bile for elimination from the body. Copper is a component of many enzymes, including ones that are necessary for the following:

  • Energy production

  • Formation of red blood cells, bone, or connective tissue (which binds other tissues and organs together)

  • Antioxidant action (to help protect cells against damage by free radicals, which are reactive by-products of normal cell activity)

(See also Overview of Minerals.)

Copper deficiency may be acquired or inherited. It is rare among healthy people and occurs most commonly among infants who are

  • Premature

  • Recovering from severe undernutrition

  • Having persistent diarrhea

Some male infants inherit a genetic abnormality that causes copper deficiency. This disorder is called Menkes syndrome.

In adults, copper deficiency may be caused by

  • Disorders that impair absorption of nutrients (malabsorption disorders, such as celiac disease, Crohn disease, cystic fibrosis, or tropical sprue)

  • Weight-loss (bariatric) surgery

  • Consumption of too much zinc, which reduces the absorption of copper

Symptoms

Symptoms of copper deficiency include fatigue, anemia, and a decreased number of white blood cells. Sometimes, osteoporosis develops or nerves are damaged. Nerve damage can cause tingling and loss of sensation in the feet and hands. Muscles may feel weak. Some people become confused, irritable, and mildly depressed. Coordination is impaired.

Menkes syndrome, a genetic disorder, causes severe intellectual disability, vomiting, and diarrhea. The skin lacks pigment, and the hair is sparse, steely, or kinky. Bones may be weak and malformed, and arteries are fragile, sometimes rupturing.

Diagnosis

  • A doctor's evaluation

  • Blood tests

Copper deficiency is usually diagnosed based on symptoms and on blood tests that detect low levels of copper and ceruloplasmin (a copper-carrying protein).

Early diagnosis and treatment of copper deficiency seem to result in a better outcome.

Treatment

  • Treatment of the cause

  • A copper supplement or injection

The cause of copper deficiency is treated, and a copper supplement is given by mouth.

For infants with Menkes syndrome, copper is injected under the skin (subcutaneously). Despite treatment, children with Menkes syndrome usually die before they are 10 years old.

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