Copper status in multiple trauma patients: measurement of copper balance, serum copper and ceruloplasmin

Changes in copper metabolism have been reported in both thermal injury and skeletal trauma; data regarding copper status in multiple trauma patients (MTP) are nonexistent. Hypercatabolism following multiple trauma may increase copper utilization, deplete copper stores and compromise cuproenzyme synthesis and function. The purpose of this study was to provide information on copper status in MTP and determine whether age, injury severity, clinical outcome or nutritional intake influenced copper status. Twenty-four hour copper losses, serum copper and ceruloplasmin were measured in 11 MTP with Injury Severity Scores (ISS) >12 at 24-48 hours post admission. Collections of biological fluids (urine, nasogastric, chest tube, drains, stools) were analyzed for copper using atomic absorption spectrophotometry (AAS) and quantified over 5 days. Serial serum copper and ceruloplasmin were determined on days 1,3,5,10,15 and patient discharge by ASS and rate nephelometry inmunoprecipition, respectively. Eight patients received parenteral nutrition (PN). Three received intravenous glucose/electrolyte infusions (IV). urine (n=11) and nasogastric losses (n=8) were statistically greater than normal (p<.001). The mean ± SEM cumulative copper losses of urine, chest tube drainage, nasogastric secretions and other drains were 790 ± 116 (n=11), 833 ± 130 (n=7), 261 ± 46 (n+8), and 150 ± 58 μg/5 d (n=8), respectively. Urinary losses represented 10 to 12 times the normal copper excretion. Serum copper on day 1 and ceruloplasmin day 3 were significantly higher than normal (p<.025). Cumulative copper balance in the IV group was - 2266 μg and -440 μg in the PN group. No relationship was found between copper loss and ISS. Patients in their twenties demonstrated the greatest urinary copper loss. The physiological and biochemical effects of extensive copper loss in the MTP require further evaluation. These patients may have a predisposition to copper deficiency due to excessive copper losses and may require increased copper supplementation.