title: Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement.
abstract: OBJECTIVE
  Several trace elements are essential for immunity and wound healing, particularly after major burns. Continuous renal replacement therapy (CRRT), which is used to treat renal failure, causes significant trace elements losses. The aim of the present review is to update the current literature and draw attention to this type of complication, as copper deficiency is rarely suspected and diagnosed in clinical conditions and may occur in chronic critically ill patients.
  
  
  METHODS
  This is an emblematic case report and review of literature.
  
  
  RESULTS
  Major copper and selenium deficiencies were documented in a patient with major burns complicated by renal failure. The main cause was effluent loss during prolonged CRRT. The copper deficit resulted in life-threatening bradycardia and the alteration of lipid metabolism with severe hypertriglyceridemia. The published data are scarce, but trace element losses with effluent have been previously documented, as has the affect of copper deficiency on cardiac rhythm.
  
  
  CONCLUSIONS
  The literature regarding the specific requirements for chronically critically ill patients is limited. During prolonged CRRT, copper and selenium levels decrease and probably should be monitored during prolonged therapy. Research in this area is required.
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), Lausanne, Switzerland. Electronic address: Nawfel.benhamouda@chuv.ch.
authors.forename: Nawfel
authors.initials: N
authors.lastname: Ben-Hamouda
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Charrière
authors.affiliation: Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voirol
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000097:blood / Q000209:etiology; D003300:Copper / Q000097:blood / Q000172:deficiency*; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000209:etiology; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D050356:Lipid Metabolism; D008297:Male; D051437:Renal Insufficiency / Q000097:blood / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000009:adverse effects* / Q000379:methods; D012643:Selenium / Q000097:blood / Q000172:deficiency*
chemical_list: D003300:Copper; D012643:Selenium
keywords: Acute deficiency; Cardiac arrhythmia; Chronic critical illness; Lipid metabolism; Renal failure; Trace elements