title: The risk of copper deficiency in patients prescribed zinc supplements.
abstract: OBJECTIVE
  In high doses zinc may cause copper deficiency, a diagnosis that is often missed resulting in anaemia, neutropenia and irreversible neurological symptoms. The aim of this study was to assess if zinc deficiency is erroneously diagnosed by misinterpretation of plasma zinc concentrations and whether copper deficiency is induced in patients prescribed zinc.
  
  
  METHODS
  Casenotes of 70 patients prescribed zinc were scrutinised. Plasma concentrations of zinc, copper, C reactive protein and albumin were recorded from the laboratory database.
  
  
  RESULTS
  62% of patients were prescribed zinc at doses sufficient to cause copper deficiency. In 48% of the patients, plasma zinc concentrations were low as a probable result of hypoalbuminaemia or the systemic inflammatory response rather than deficiency. Awareness of copper deficiency was lacking; it was only documented as a possible side effect in one patient and plasma copper was measured in only two patients prescribed zinc. 9% of patients developed unexplained anaemia and 7% developed neurological symptoms typical of copper deficiency.
  
  
  CONCLUSIONS
  Zinc deficiency is frequently misdiagnosed on the basis of low plasma zinc concentrations. The potential risk of copper deficiency developing in patients prescribed high doses of zinc is apparently infrequently considered. It is probable that a significant minority of patients prescribed with high doses of zinc develop iatrogenic copper deficiency.
authors.affiliation: Scottish Trace Element and Micronutrient Reference Laboratory, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Duncan
authors.affiliation: Department of Paediatric Surgery, Yorkhill Hospital, Glasgow, UK.
authors.forename: Calum
authors.initials: C
authors.lastname: Yacoubian
authors.affiliation: Department Biochemistry, Edinburgh Royal Infirmary, Little France, Edinburgh, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Watson
authors.affiliation: Department of Neurology, Ninewells Hospital, Dundee, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Morrison
mesh_terms: D003300:Copper / Q000097:blood / Q000172:deficiency*; D019587:Dietary Supplements / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors; D015032:Zinc / Q000097:blood* / Q000172:deficiency / Q000627:therapeutic use*
chemical_list: D003300:Copper; D015032:Zinc
keywords: HAEMATOLOGY; LABORATORY TESTS; NEUROPATHIES; TOXICOLOGY