PT  - JOURNAL ARTICLE
AU  - Andrew Duncan
AU  - Calum Yacoubian
AU  - Neil Watson
AU  - Ian Morrison
TI  - The risk of copper deficiency in patients prescribed zinc supplements
AID  - 10.1136/jclinpath-2014-202837
DP  - 2015 Sep 01
TA  - Journal of Clinical Pathology
PG  - 723--725
VI  - 68
IP  - 9
4099  - http://jcp.bmj.com/content/68/9/723.short
4100  - http://jcp.bmj.com/content/68/9/723.full
SO  - J Clin Pathol2015 Sep 01; 68
AB  - Aims In high doses zinc may cause copper deficiency, a diagnosis that is often missed resulting in anaemia, neutropenia and irreversible neurological symptoms. The aim of this study was to assess if zinc deficiency is erroneously diagnosed by misinterpretation of plasma zinc concentrations and whether copper deficiency is induced in patients prescribed zinc.Methods Casenotes of 70 patients prescribed zinc were scrutinised. Plasma concentrations of zinc, copper, C reactive protein and albumin were recorded from the laboratory database.Results 62% of patients were prescribed zinc at doses sufficient to cause copper deficiency. In 48% of the patients, plasma zinc concentrations were low as a probable result of hypoalbuminaemia or the systemic inflammatory response rather than deficiency. Awareness of copper deficiency was lacking; it was only documented as a possible side effect in one patient and plasma copper was measured in only two patients prescribed zinc. 9% of patients developed unexplained anaemia and 7% developed neurological symptoms typical of copper deficiency.Conclusions Zinc deficiency is frequently misdiagnosed on the basis of low plasma zinc concentrations. The potential risk of copper deficiency developing in patients prescribed high doses of zinc is apparently infrequently considered. It is probable that a significant minority of patients prescribed with high doses of zinc develop iatrogenic copper deficiency.