# Optimizing Treatment in Refractory Copper Deficiency: A Case Report

## TL;DR

A woman with a history of gastric bypass surgery had treatment-resistant copper deficiency, which improved only after adjusting the IV copper administration frequency.

## Contribution

Demonstrates that standard IV copper protocols may be insufficient for post-gastric bypass patients, suggesting the need for individualized treatment.

## Key findings

- Standard IV copper regimen (2 mg daily for five days every four to six weeks) failed to correct copper deficiency over two years.
- Increasing IV copper frequency to 2 mg twice weekly rapidly normalized copper levels.
- Refractory copper deficiency in post-gastric bypass patients may require tailored treatment approaches.

## Abstract

Copper deficiency, though rare, is increasingly observed in patients who have undergone Roux-en-Y gastric bypass due to impaired absorption in the stomach, proximal duodenum, and small intestine. Deficiency may manifest as anemia, cytopenias, and myeloneuropathy. Standard treatment includes oral or intravenous (IV) copper supplementation, with IV replacement preferred in cases of malabsorption.

We present a case of treatment-resistant copper deficiency in a woman in her late forties with a history of Roux-en-Y gastric bypass and iron-deficiency anemia, who presented with lower extremity paresthesias. Laboratory evaluation revealed severe copper deficiency (serum copper: 10 µg/dL; normal 80-155 µg/dL). Despite oral supplementation and the standard IV copper regimen (2 mg daily for five days every four to six weeks) over a two-year period, her copper levels remained low. A revised regimen of IV copper at 2 mg twice weekly resulted in a rapid normalization of her copper levels.

This case highlights the potential limitations of standard copper replacement protocols in post-gastric bypass patients. Adjusting the frequency of IV copper administration may improve outcomes in cases of refractory copper deficiency. Individualized treatment regimens should be considered when standard protocols are ineffective.