Copper levels in cholestatic infants on parenteral nutrition.

BACKGROUND Copper levels are primarily regulated by biliary excretion. In cholestatic patients, there is a concern that the standard dose of copper in parenteral nutrition (PN) will result in excessive copper levels. This study looked retrospectively at cholestatic infants receiving PN with measured copper levels to ascertain if this is an actual clinical concern. METHODS All infants from the previous 10 years receiving PN who had a copper level checked and were cholestatic were reviewed. Children with metabolic or liver structural anomalies were excluded from the review. Of the 28 patients found, 26 had gastrointestinal disorders, and 82% of these infants were on the standard PN copper dose (20 µg/kg/d). RESULTS Only one elevated copper level was found in a child with congenital heart disease, but 13 low levels were found. A smaller number of follow-up copper levels demonstrated that despite cholestasis, some patients require copper supplementation above standard recommendations. CONCLUSION Cholestasis does not appear to impair copper excretion enough to result in elevated levels. In fact, infants with gastrointestinal disorders may require higher than standard dosing. Monitoring copper levels appears to be necessary to appropriately regulate copper dosing for cholestatic infants receiving PN.