(419) Evaluation of Copper Deficiency Treatment in Critically Ill Patients

Introduction: Copper (Cu) is an essential micronutrient and deficiency can lead to poor wound healing, myeloneuropathy, anemia, and cardiac arrhythmias. Cu deficiency has been reported in ICU patients with burns, requiring continuous renal replacement therapy (CRRT), and with history of bariatric surgery. Limited guidance on Cu monitoring and repletion exists for ICU patients. The European Society for Parenteral and Enteral Nutrition (ESPEN) suggests obtaining C-reactive protein (CRP) with Cu levels, as Cu serum concentrations increase during inflammation. ESPEN and the American Society of Metabolic and Bariatric Surgery provide general Cu dosing recommendations of 3-8 mg orally for moderate deficiency and 2-8 mg/day IV via slow infusion for severe deficiency, with no specific durations. ASPEN has no Cu repletion recommendations for ICU patients. Our aim is to evaluate Cu monitoring and repletion practices at our institution to determine if Cu deficiency treatment is in concordance with available recommendations.

Methods: This retrospective review evaluated adults (≥18 years) admitted to an ICU at Vanderbilt University Medical Center from 7/1/2022 to 6/30/2023 who received Cu repletion. Descriptive statistics were used to summarize data. Data are mean (SD) or median (interquartile range).

Results: Of the 38 patients who received Cu repletion, 28.9% were admitted to burn ICU, 26.3% were admitted to the CVICU, and 34.2% required CRRT. All patients had ≥1 Cu level and 50% had a CRP drawn with initial Cu level. Fifty-five percent received oral Cu dosed at 2.6 mg (1). When used, IV Cu was dosed at 2.1 mg (1.2), infused at 1.5 mg/hour (0.6). Cu therapy was continued for 22 days (9-39).

Conclusions: Patients with Cu deficiency were commonly admitted to burn or CV ICUs and many required CRRT. Cu monitoring was inappropriate in many patients as CRP was not trended simultaneously to monitor for effects of inflammation and it is difficult to interpret reported Cu levels. Oral Cu doses were utilized frequently and at low doses. IV Cu doses were infused rapidly which may decrease efficacy. Development of a standardized Cu monitoring and repletion guideline would guide clinicians in managing Cu deficiency and could then be used to determine optimal Cu dosing in this population.