Copper is important in several enzymes, including:
(1) cytochrome C oxidase
(2) amine oxidase
(3) lysyl oxidase
(4) tyrosinase
(5) superoxide dismutase
(6) ceruloplasmin
(7) S-adenosylhomocysteine hydrolase
(8) dopamine beta-hydroxylase
(9) Factor V
(10) ascorbate oxidase
Clinical states associated with copper malnutrition:
(1) TPN without copper supplementation
(2) malabsorption states
(3) inflammatory bowel disease
(4) protein malnutrition
(5) high oral doses of zinc or iron
(6) premature infants
(7) malnourished infants
(8) nephrotic syndrome
(9) chronic infection or inflammation
(10) pregnancy
(11) hepatitis or cirrhosis
(12) cancer
where:
• Patients with protein malnutrition, nephrotic syndrome and malabsorption may have low serum copper levels yet adequate copper stores.
Clinical findings in a deficiency state:
(1) pancytopenia, with a hypochromic, normochromic or megaloblastic anemia unresponsive to iron
(2) kinky hair
(3) skeletal demineralization with osteoporosis and defects in metaphysis
(4) myocardial disease, which may be fatal
(5) delayed wound healing
(6) depigmentation with loss of hair and skin color
(7) lethargy and neurologic disturbances
