Related Experiment Video
Updated: May 22, 2026
Isolation of Neonatal Extrahepatic Cholangiocytes
Published on: June 5, 2014
Copper levels in cholestatic infants on parenteral nutrition
Mark R Corkins1, Valerie A Martin, Elaina E Szeszycki
1Indiana University School of Medicine, Indianapolis, Indiana, USA. mrcorkin@pol.net
Insights
Cholestasis in infants does not typically cause high copper levels from parenteral nutrition (PN). Some infants with gastrointestinal disorders may even need higher copper doses, necessitating careful monitoring.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Hepatology
Background:
- Copper homeostasis is mainly controlled by biliary excretion.
- Concerns exist regarding excessive copper accumulation in cholestatic infants receiving standard parenteral nutrition (PN) doses.
- This study retrospectively evaluated copper levels in cholestatic infants on PN.
Purpose of the Study:
- To determine if standard PN copper doses lead to excessive copper levels in cholestatic infants.
- To assess the clinical significance of copper regulation in this patient population.
Main Methods:
- Retrospective review of cholestatic infants receiving PN over 10 years with documented copper levels.
- Exclusion of infants with metabolic or structural liver anomalies.
- Analysis of copper levels in 28 eligible infants, with 82% receiving standard copper dosing (20 µg/kg/d).
Main Results:
- Only one infant showed an elevated copper level (associated with congenital heart disease).
- Thirteen infants presented with low copper levels.
- Follow-up measurements indicated that some cholestatic infants require copper supplementation exceeding standard recommendations.
Conclusions:
- Cholestasis does not significantly impede copper excretion to cause toxicity.
- Infants with gastrointestinal disorders may require increased copper dosing.
- Regular monitoring of copper levels is crucial for optimizing PN in cholestatic infants.
Background:
Copper levels are primarily regulated by biliary excretion. In cholestatic patients, there is a concern that the standard dose of copper in parenteral nutrition (PN) will result in excessive copper levels. This study looked retrospectively at cholestatic infants receiving PN with measured copper levels to ascertain if this is an actual clinical concern.
Methods:
All infants from the previous 10 years receiving PN who had a copper level checked and were cholestatic were reviewed. Children with metabolic or liver structural anomalies were excluded from the review. Of the 28 patients found, 26 had gastrointestinal disorders, and 82% of these infants were on the standard PN copper dose (20 µg/kg/d).
Results:
Only one elevated copper level was found in a child with congenital heart disease, but 13 low levels were found. A smaller number of follow-up copper levels demonstrated that despite cholestasis, some patients require copper supplementation above standard recommendations.
Conclusion:
Cholestasis does not appear to impair copper excretion enough to result in elevated levels. In fact, infants with gastrointestinal disorders may require higher than standard dosing. Monitoring copper levels appears to be necessary to appropriately regulate copper dosing for cholestatic infants receiving PN.
Related Concept Videos
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:20Cholecystitis