Copper is a component of many body proteins; almost all of the body’s copper is bound to copper proteins. Unbound (free) copper ions are toxic. Genetic mechanisms control the incorporation of copper into apoproteins and the processes that prevent toxic accumulation of copper in the body. Copper absorbed in excess of metabolic requirements is excreted through bile.
Acquired copper toxicity can result from ingesting or absorbing excess copper (eg, from ingesting an acidic food or beverage that has had prolonged contact with a copper container). Self-limited gastroenteritis with nausea, vomiting, and diarrhea may occur.
More severe toxicity results from ingestion (usually with suicidal intent) of gram quantities of a copper salt (eg, copper sulfate) or from absorption of large amounts through the skin (eg, if compresses saturated with a solution of a copper salt are applied to large areas of burned skin). Hemolytic anemia and anuria can result and may be fatal.
Indian childhood cirrhosis, non-Indian childhood cirrhosis, and idiopathic copper toxicity are probably identical disorders in which excess copper causes cirrhosis. All appear to be caused by ingesting milk that has been boiled or stored in corroded copper or brass vessels. Studies suggest that idiopathic copper toxicity may develop only in infants with an unknown genetic defect.
Diagnosis of acquired copper toxicity usually requires liver biopsy, which may show Mallory hyalin bodies.
Treatment of Copper Toxicity
- Supportive measures
For copper toxicity due to ingesting grams of copper, prompt gastric lavage is done. Copper toxicity that causes complications such as hemolytic anemia, anuria, or hepatotoxicity is also treated with chelation therapy with one of the following:
- Oral penicillamine 250 mg every 6 hours to 750 mg every 12 hours (1000 to 1500 mg/day in 2 to 4 doses)
- Dimercaprol 3 to 5 mg/kg IM every 4 hours for 2 days, then every 4 to 6 hours)
If used early, hemodialysis may be effective.
Occasionally, copper toxicity is fatal despite treatment.
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