Anatomic and histologic changes of early emphysema.

Assuming the maximum copper level 210 g per cent was administered to the patient, the copper dose administered would be approximately 3.15 mg/day, normal copper intake as quoted by the authors 2-3 mg/day.2 The authors suggest that a dose of six times this amount (20mg) is acceptable. If one takes into account that the average expired copper level was 134 g percent, the actual dose is likely to be in the range of 1.14mg/day. It should also be borne in mind that in our experience 50 percent of patients receiving continuous ventilator support do so for 48 hours or less, and that only 10 percent are on ventilators for longer than seven to ten days. Perhaps a comparison between dialysis machines and nebulized water containing small amounts of copper is not a valid one. In conclusion, the authors’ suggested alternative of adding CuC12 would be hazardous in terms of: 1) the risk of contaminating the closed system; 2) error in adding the correct dose of CuC12, and 3) exposing the patient to six times the copper dose required to maintain sterility of the nebulizer contents.