PD214 - TRACE ELEMENT DILEMMA IN HOME PARENTERAL NUTRITION: COPPER DEFICIENCY AFTER WITHDRAWAL IN IFALD

PD214

TRACE ELEMENT DILEMMA IN HOME PARENTERAL NUTRITION: COPPER DEFICIENCY AFTER WITHDRAWAL IN IFALD

M. A. Calzada^1,*, L. Hernandez¹, C. Soler ¹, S. Mir¹

¹Nutrición, Diabetes y Metabolismo, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

Rationale: Copper (Cu) deficiency may occur in patients with intestinal failure (IF) receiving home parenteral nutrition (HPN), particularly when trace elements (TE) are withheld due to cholestasis. We report a case of Cu deficiency in IF with short bowel syndrome (SBS), highlighting diagnostic and management challenges.

Methods: An 18-year-old female developed IF after extensive intestinal resection (120 cm of small bowel anastomosed to the colon) following mesenteric ischemia. She was on cyclic HPN (4 days/week) with good oral tolerance. She developed cholestasis in the setting of IF-associated liver disease (IFALD) and drug-induced liver injury, leading to TE withdrawal and discontinuation of olanzapine, with subsequent improvement in liver function. One month later, she presented with macrocytic anemia and leukopenia, with normal vitamin B12, folate, and iron studies; low serum copper and ceruloplasmin confirmed Cu deficiency. TE were reintroduced (2 ampoules added to HPN), and oral copper bisglycinate (3 mg/day) was initiated due to lack of intravenous copper formulations.

Results: Blood counts normalized and serum copper levels increased after supplementation. Recommended Cu intake in HPN is 0.3–0.5 mg/day, whereas standard TE formulations provide 1 mg, increasing the risk of excess in cholestatic patients due to biliary excretion. TE withdrawal, however, increases the risk of deficiency. No standardized strategy exists; monitoring serum copper and ceruloplasmin may guide individualized supplementation.

Conclusion: Copper management in HPN requires an individualized approach, particularly in IFALD. Fixed-dose trace element formulations may not meet patient-specific needs, and complete withdrawal may lead to clinically significant deficiency. Biochemical monitoring with clinical assessment is essential to guide tailored supplementation and prevent both deficiency and accumulation during long-term PN.

Disclosure of Interest: None declared