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Zinc and copper metabolism in acute viral hepatitis

Patients with acute viral hepatitis were found to have decreased serum concentrations of total zinc, increased serum concentrations of diffusible zinc, and increased urinary zinc excretion. As the illness subsided serum concentrations of total zinc rose to normal, serum concentrations of diffusible zinc fell to normal, and urinary zinc excretion decreased. Total serum zinc concentration was related inversely to serum diffusible zinc and directly to plasma levels of retinol-binding protein (RBP) and total protein. Serum diffusible zinc was inversely related to plasma RBP and total protein and directly to plasma bilirubin and serum copper. The changes in serum and urinary zinc may be related to changes in the manner by which zinc is bound to serum proteins, particularly albumin. Total serum copper concentrations were normal in the early, acute phase of this clisease but increased to greater than normal levels as the illness subsided. This increase was accounted for entirely by increases in the concentration of ceruloplasmin copper.