We have previously reported that hypercupremia occurs in up to 19% of individuals after bariatric surgery (Lee J, et al. Am J Gastroenterol, 2012). The national recommendation for two multivitamins with minerals daily for these patients (4 mg copper daily) may provide an excess of oral copper. A 30s-year-old female (BMI 49) underwent vertical sleeve gastrectomy with no immediate postoperative complication. When seen 5 months after surgery, she was taking two chewable multivitamins with minerals daily (4 mg elemental Cu and 24 mg elemental Zn daily). Hypercupremia was present, in association with elevated ceruloplasmin, noted in retrospect (see Table 1). Follow-up blood tests showed persistently normal levels of AST, ALT, alkaline phosphatase, and albumin. At 11 months after surgery, she was instructed to stop the multivitamins. At 12 months, when hypercupremia persisted, she started one Cu-free multivitamin daily. Despite this, high levels of serum Cu persisted at the 14-month visit. A search for underlying causes showed normal protein electrophoresis (no M-spike), negative celiac disease markers, and negative ANA. Of note, urinary copper excretion was normal at 15 mcg/24 hours (normal, < 35). She was instructed in a lowcopper diet. At the 2-year visit, she had realized a loss of 44% of her excess preoperative weight. Hypercupremia was still present. Slit lamp examination showed no Kayser-Fleischer rings. She was started on zinc sulfate 220 mg before meals twice daily (100 mg elemental Zn). On follow-up 2 months later, serum Cu and ceruloplasmin had essentially normalized. Hypercupemia after bariatric surgery may be related to ingestion of the high doses of Cu present in multivitamins with mineral supplements. In this case, the high levels of serum Cu correlated with high levels of ceruloplasmin. At the same time, the normal urinary Cu excretion and absence of K-F rings excluded a more general copper overload syndrome. It is unclear whether increased production of ceruloplasmin in this case was perhaps an independent response to significant weight loss, or was simply a reflection of an excess of available copper. Oral zinc can be an effective treatment to diminish copper overload in individuals with Wilson's disease. The mechanism of zinc's apparently beneficial effect in this patient is unclear, but may be related to suppression of ceruloplasmin secretion from the liver.2452 Figure 1 No Caption available.