Pregnant women require an increased an amount of iron, but they need to
avoid a megadose in the first trimester because it might cause birth defects.
Larger doses of iron are necessary in the second and third trimester. Iron is
absorbed in the intestine where it enters plasma as heme or is stored as ferritin
in the liver, spleen, and bone marrow. Food, the antibiotic tetracycline, and
antacids decrease absorption up to 50% of iron. However, the patient should take
iron with food to avoid GI discomfort. Vitamin C may slightly increase iron
absorption. Iron toxicity is a serious cause of poisoning in children. Toxicity can
develop with as few as 10 tablets of ferrous sulfate (3g) taken at one time—and
can be fatal within 12 to 48 hours.
CopperCopper is used in the formation of red blood cells and connective tissues. It is
also a cofactor for many enzymes. Without copper enzymes are unable to initi-
ate metabolic reactions in the body. Copper is also a component in the produc-
tion of the neurotransmitters norepinephrine and dopamine. Foods rich in copper
are shellfish (crabs and oysters), liver, nuts, seeds (sunflower, sesame), legumes,
and cocoa. It is absorbed in the intestines. A prolonged copper deficiency can
result in anemia and cause changes in the skin and blood including a decrease in
the white blood count, intolerance to glucose, decrease in skin and hair pigmen-
tation, and mental retardation if the patient is young. High levels of copper in
serum can be an indication of Wilson’s disease, which is an inborn error of
metabolism that allows for large amounts of copper to accumulate in the liver,
brain, cornea, or kidney.
CHAPTER 9 Vitamins and Minerals^151
Dose 1.5–3 mg/day
Maintenance 1.5–3mg/day
Pregnancy category A (C if > RDA dose)
Deficiency conditions Anemia, decreased WBCs, glucose intolerance, decrease in
skin and hair pigmentation, and mental retardation in the
young.
Side effects None significant
Adverse reactions Vomiting and diarrhea
Contraindications None knownCopper