534 Persistent Copper and Zinc Deficiency in Excess of 30 Days Post Burn Injury

Abstract

Abstract Introduction Copper and zinc deficiencies are common after burn injury, with the lowest levels usually occurring within seven days. Both trace elements are important for wound healing, but due to competition for absorption in the small intestine, oral replacement of zinc and copper may not be sufficient. Nutritional guidelines recommend copper and zinc replacement for up to 30 days, but little data is available to guide long-term trace element replacement. Methods This case series includes four patients with 15% or larger total body surface area burns who had hypocupremia at least 30 days after admission despite receiving at least the recommended daily allowance of copper via tube feeds. Results In two patients, copper levels increased following discontinuation of oral zinc tablets. However, one patient had continued hypocupremia and increasing zinc levels while receiving zinc only from tube feeds, suggesting this amount of zinc may decrease dietary copper absorption. For one patient with 95% TBSA burns, hypocupremia was associated with polyneuropathy and osteopenia. Another patient experienced an acute drop in zinc levels associated with bacteremia and sepsis. Conclusions In this case series, hypocupremia was associated with anemia and zinc deficiency with poor wound healing. Additional multicenter practice reviews of copper and zinc supplementation in burn centers would be beneficial.