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Burn severity, copper dose, and plasma ceruloplasmin in burned children during total parenteral nutrition
J J Cunningham1, M Leffell, P Harmatz
1Nutritional Support Unit, Shriners Burns Institute, Boston, MA 02114.
Insights
Severe burn patients receiving copper (Cu) via total parenteral nutrition (TPN-Cu) showed low ceruloplasmin (CP) levels. Supplementation up to 20 micrograms/kg/day appears safe and potentially beneficial for these children.
Area of Science:
- Biochemistry
- Pediatric Nutrition
- Trauma Care
Background:
- Copper (Cu) is vital for metabolism and wound healing.
- Ceruloplasmin (CP) is the main Cu-transport protein and an acute-phase reactant.
- Severe burn trauma can disrupt normal CP response, even with Cu provision.
Purpose of the Study:
- To evaluate copper (Cu) levels and ceruloplasmin (CP) response in severely burned children receiving total parenteral nutrition (TPN-Cu).
- To assess the safety and efficacy of varying TPN-Cu doses in this patient population.
- To determine optimal TPN-Cu supplementation strategies for pediatric burn patients.
Main Methods:
- Studied 14 severely burned children receiving TPN-Cu (7-26 micrograms Cu.kg-1 x day-1).
- Measured plasma CP levels and calculated non-ceruloplasmin copper (nonCP-Cu).
- Correlated Cu dosage with CP levels, burn severity, and potential hepatotoxicity markers.
Main Results:
- All patients exhibited low plasma CP levels, reflecting burn severity and Cu dose dependency.
- Plasma nonCP-Cu levels remained within safe limits, indicating no increased risk of hepatotoxicity.
- TPN-Cu at 20 micrograms.kg-1 x day-1 was found to be safe and reasonable for severely burned children.
Conclusions:
- Low CP levels in severely burned children on TPN-Cu are common but may be influenced by Cu dosage.
- TPN-Cu supplementation up to 20 micrograms.kg-1 x day-1 is safe for pediatric burn patients.
- Higher Cu doses (>20 micrograms/kg/day) may offer benefits, warranting continued monitoring of CP and total Cu.
Abstract:
Copper (Cu) is an essential nutrient with known metabolic roles in wound healing. Ceruloplasmin (CP), the primary Cu-transport protein, responds as an acute-phase reactive protein after trauma. However, for severe burn trauma, this response is absent in the early catabolic phase despite Cu provision. We report data for 14 severely burned children receiving Cu in total parenteral nutrition (TPN-Cu) ranging from 7 to 26 micrograms Cu.kg-1 x day-1. All patients manifested low plasma levels of CP. The reduction in CP reflected burn severity but also appeared to be dependent on the Cu dose. Increasing Cu supplementation to improve CP raises a concern for hepatotoxicity, which is accompanied by an elevation in the plasma nonceruloplasmin Cu (nonCP-Cu). The calculated plasma nonCP-Cu in our series is consistent with a lack of increased risk and suggests that TPN-Cu at the general pediatric guideline of 20 micrograms.kg-1 x day-1 is safe and reasonable for severely burned children. Cu supplementation > 20 micrograms/kg may be beneficial; however, monitoring of both CP and total Cu should continue as standard practice in the management of these patients.