title: Assessing copper status in pediatric patients receiving parenteral nutrition.
abstract: BACKGROUND
  Copper is a trace mineral essential for numerous physiological processes. The purpose of this article is to provide data on copper levels in pediatric patients receiving parenteral nutrition (PN) that are useful to guide supplementation in PN formulation.
  
  
  METHODS
  This is a retrospective review of hospitalized pediatric patients receiving PN supplemented and not supplemented with copper. In total, 751 supplemented pediatric patients and 90 pediatric patients not supplemented had serum copper levels measured. We assessed patient demographics, days on PN before copper level was drawn, serum copper levels, conjugated bilirubin levels, and C-reactive protein (CRP).
  
  
  RESULTS
  The mean serum copper level was 80 mcg/dL at 20 days for supplemented patients and 64 mcg/dL at 14 days for the 90 nonsupplemented patients (P = .0002). In the supplemented patients, 50% of the levels were low and 45% were within the normal range. The remaining 5% of patients had high levels. In nonsupplemented patients, 71% were low and 29% within the normal range. There was no correlation between copper levels and conjugated bilirubin <2 mg/dL and >2 mg/dL (P = .3421). Copper levels correlated with CRP for CRP >4 mg/dL (P = .03).
  
  
  CONCLUSIONS
  Pediatric patients receiving PN should be supplemented with copper to prevent deficiency. Serum copper levels should be assessed at 14 days. Assessment of copper status should not be determined by conjugated bilirubin levels. Serum copper levels may be elevated in patients with acute inflammation and may be falsely elevated when CRP is >4 mg/dL.
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah mark.mackay@imail.org.
authors.forename: Mark
authors.initials: M
authors.lastname: MacKay
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Cecilia W
authors.initials: CW
authors.lastname: Mulroy
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Street
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Charisse
authors.initials: C
authors.lastname: Stewart
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Jake
authors.initials: J
authors.lastname: Johnsen
authors.affiliation: Primary Children's Medical Center, Salt Lake City, Utah.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Irasema
authors.initials: I
authors.lastname: Paul
mesh_terms: D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003300:Copper / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014131:Trace Elements / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency*; D016896:Treatment Outcome
chemical_list: D014131:Trace Elements; D003300:Copper; D002097:C-Reactive Protein; D001663:Bilirubin
keywords: copper; micronutrients; minerals/trace elements; nutritional assessment; parenteral nutrition; pediatrics; trace elements