Retrospective Evaluation of IV Copper in Thermally Injured Patients: A Single-Center Experience

Introduction: Severe burn injuries induce profound metabolic and inflammatory responses, significantly altering micronutrient homeostasis. Copper plays a critical role in wound healing, immune function, antioxidant defense, and connective tissue integrity and is often depleted in burn patients due to increased losses through wound exudate, hypermetabolic demands, and impaired gastrointestinal absorption. Dosing strategies are not well-established for intravenous (IV) copper; however, at our institution, standard IV copper treatment consists of a minimum of 2mg daily for five days for patients with total body surface area (TBSA) burns greater than 20% or documented low copper levels. Outside of this protocol, patients receive oral copper via multivitamins and tube feeds, if applicable. The aim of this study is to assess whether our IV copper repletion practice is sufficient to achieve therapeutic serum copper levels in critically ill burn patients.


Methods: Single-center, retrospective analysis of adult and pediatric burn patients admitted to the burn ICU between 11/3/24 and 7/2/25 who received IV copper. Descriptive statistics were used to summarize clinical data. Data is represented as mean (standard deviation) or median (interquartile range). Pearson correlation was used to assess the relationship between TBSA and copper levels.


Results: Forty-five patients received copper replacement during the study period, 82% having >20% TBSA burns. The median baseline copper level amongst all patients was 54 mcg/mL (45-64.5) prior to treatment and despite oral copper supplementation. TBSA burns greater than 20% correlated with lower copper levels at baseline (r=-0.39) and lower post-repletion levels (r=-0.47). This often required more than five days of IV copper to reach targeted levels. The median amount of IV copper administered prior to repeat level was 10 mg (8-15). The average total days of IV repletion was 12 days (± 3.3) and increased with higher TBSA.


Conclusions: These results suggest that our current practice of IV copper repletion is not sufficient to achieve therapeutic levels after initial dosing. This suggests that a more aggressive approach to IV copper repletion is necessary, and additional research is needed to determine the optimal repletion regimen based on TBSA.