Acute Copper Toxicity: Succimer Makes you Less Blue

INTRODUCTION: Acute copper toxicity is a rare occurrence, and management guidelines are not based on robust evidence. Treatment recommendations are often extrapolated from those of chronic copper intoxication and the management of Wilson's disease. Although D-penicillamine, EDTA, and dimercaprol have varying success, we describe the use of chelation with succimer monotherapy in a patient with acute copper salt ingestion with subsequent improvement of clinical status and copper concentrations. CASE REPORT: A 38-year-old woman presented to an ED after ingestion of liquid copper fungicide containing 27.5% copper diammonia diacetate complex. The regional poison center initially recommended D-penicillamine along with supportive care. Due to the lack of availability of D-penicillamine, succimer was chosen as an alternative agent. The patient developed mild hemolysis and liver injury during her stay, but did not develop any kidney injury. She had a Zargar 2A caustic injury to the stomach and duodenal bulb. She received succimer for a total of 10 days, and copper concentrations decreased from 1,295 mcg/dL (reference range: 80-158 mcg/dL) to normal levels before discharge. DISCUSSION: There is limited evidence surrounding chelation therapy in acute copper poisoning. We describe a case of a patient who clinically improved while receiving aggressive supportive care and associated succimer monotherapy after acute ingestion of a copper compound.