ZINC-INDUCED COPPER DEFICIENCY IN AN INFANT

Objective. - To describe the case of a 13-month-old girl who developed copper deficiency as a result of excessive zinc gluconate ingestion. Setting. - Tertiary care hospital in Syracuse, NY. Interventions. - Cessation of zinc ingestion followed by intravenous and oral copper chloride therapy. Measurements/Main Results. - Ingestion of zinc gluconate, 120 mg/d for 6 months, and thereafter 180 mg/d for 1 month, preceded the clinical presentation of listlessness, anemia, neutropenia, poor weight gain, abnormal sparse hair, and scorbuticlike bone changes. Findings on a bone marrow examination included ring sideroblasts and suggested copper deficiency. Plasma zinc level was 36.7-mu-mol/L, serum ceruloplasmin level was 20 mg/L, and serum copper level was undetectable. Clinical and laboratory abnormalities resolved shortly after initiation of copper therapy. Conclusions. - This case demonstrates the reciprocal relationship of copper and zinc metabolism and exemplifies the important interrelationships of dietary trace minerals.