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Environmental and Workplace Health

Copper

1992

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Table of Contents

The aesthetic objective for copper in drinking water is≤1.0 mg/L; this was set to ensure palatability and to minimize staining of laundry and plumbing fixtures. Copper is an essential element in human metabolism, and it is well-known that deficiency results in a variety of clinical disorders, including nutritional anaemia in infants. Although the intake of large doses of copper has resulted in adverse health effects, the levels at which this occurs are much higher than the aesthetic objective.

General

Copper occurs in nature as the metal and in minerals, most commonly cuprite (Cu2O) and malachite (Cu2CO3(OH)2). The principal copper ores are sulphides, oxides, and carbonates.(Footnote 1)

Copper has been known, mined, and used by humans for more than 5000 years. It is probably second only to iron in its usefulness to humans. Copper pipe is used extensively in plumbing, especially for domestic water systems. Copper is used in the production of electrical wire and in the manufacture of alloys such as brass and bronze.(Footnote 1,Footnote 2) It is also used in electroplating, in photography, as roofing, as a catalyst in the chemical industry, and for the removal of mercaptans in oil refining.(Footnote 3,Footnote 4) Copper is used extensively in pesticide formulations as a fungicide and antimicrobial agent, particularly for the treatment of wood and water supplies for drinking water and recreational use.

In 1981, the world production of copper from mines was 8.30 million tonnes. Canada ranked fourth, with 8.33 percent of the total production. The 1981 world production of refined copper was 9.69 million tonnes. Canada ranked sixth, producing 0.477 million tonnes.(Footnote 5) In 1975, Canadian copper mine production was concentrated in Ontario (36.6 percent), British Columbia (33.3 percent), Quebec (16.3 percent), and Manitoba (8.9 percent).(Footnote 1)

Occurrence

Copper may occur as the metal and in oxidation states as copper(I) and copper(II). An unstable copper(III) is also known. In aqueous solution, copper is present mainly as the copper(II) ion, depending on pH, temperature, the presence of bicarbonate and sulphide, and the potential to form ligands with organic species, such as humic, fulvic, and amino acids, certain polypeptides, and detergents.(Footnote 6) The free copper(I) ion can exist in aqueous solution only in exceedingly low concentrations, and the only copper(I) compounds that are stable in water are the highly insoluble ones, such as chloride or cyanide.(Footnote 7) Some copper(II) salts, including the chloride, nitrate, and sulphate, are soluble at low pH under oxidizing conditions. The carbonate, hydroxide, oxide, and sulphide are less soluble, particularly at pH 7 or higher. In alkaline waters with high carbon dioxide content, copper may precipitate as copper carbonate.(Footnote 8)

Copper and its compounds are widely distributed in nature, and copper is found frequently in surface water and in some groundwater. Based on NAQUADAT data on copper concentrations in Canadian surface and lake waters from 1980 to 1983, extractable copper levels ranged from 0.001 to 0.080 mg/L, with concentrations rarely exceeding 0.005 mg/L.(Footnote 9) Surveys of Canadian drinking water supplies in 1976 and 1977 provided information on copper levels in raw water supplies from rivers, lakes, and wells, treated drinking water at the treatment facility, and distributed water at the consumer's tap(Footnote 10) (Table 1). In another national survey, the median copper concentration in distributed water was 271 µg/L (range <10 to 900 µg/L) for 27 supplies with acid or neutral pH (90% with pH 5.3 to 7.5).(Footnote 11) In general, the ratio of copper concentrations in distributed and treated water was about 10 to 1 but ranged from 1.6 to over 100 to 1.

Table 1. Copper concentrations in Canadian drinking water supplies(Footnote 10)
Water source Raw water (µg/L) Treated water (µg/L) Distributed water (µg/L)
Mean Range Mean Range Mean Range
River ≤ 5 ≤ 5-530 ≤ 5 ≤ 5-100 20 ≤ 5-220
Lake ≤ 5 ≤ 5-80 ≤ 5 ≤ 5-100 40 ≤ 5-560
Well ≤ 5 ≤ 5-110 ≤ 5 ≤ 5-70 75 10-260

Distributed water contains considerably more copper than the original water supply because of the dissolution of copper from copper piping, which is used extensively in domestic plumbing in Canada. Soft waters with low pH, low alkalinity, and low conductivity are often more corrosive than hard waters, but these factors alone cannot be used to predict the degree of metal mobilization. Eleven water chemistry variables--potassium, sodium, calcium, magnesium, manganese, chloride, nitrate, hydrogen, sulphate, dissolved oxygen, and conductivity--were all related to the degree of elevation of copper in the water.(Footnote 12)

Because the length of time that the water stands in the pipe is also important, the most relevant data for determining actual copper intake are copper concentrations in consumed water. In an integrated monitoring survey carried out in seven Ontario communities selected as representative of soft, medium, and hard water supplies with high, moderate, or low aggressiveness, six homes in each community were equipped with a sampler attached to the kitchen tap, which sampled all water used throughout the day. The copper concentration in consumed water over a one-week sampling period averaged 176 µg/L (range 20 to 2020 µg/L). Ninety percent of all levels measured were below 300 µg/L.(Footnote 13)

Levels of copper in a range of foodstuffs are listed in Table 2. Some foods, such as shellfish (especially oysters), organ meats, nuts, dried beans, dried vine and stone fruits, and cocoa, are particularly rich in copper. The copper content of these items can range from 20 to 400 µg/kg.(Footnote 14) Dairy products, white sugar, and honey rarely have copper concentrations above 0.5 µg/kg, and non-leafy green vegetables, most fresh fruits, and refined cereals generally contain copper at levels up to 2 µg/kg.(Footnote 14) Some of the highest levels of copper can be found in tree nuts and certain condiments and spices, such as black pepper, thyme, and yeast.(Footnote 14)

Table 2. Mean copper levels in foods(Footnote 14)
Food type (mg/kg wet weight)
Seafood (finfish and shellfish) 1.49
Meat (poultry, pork, beef, lamb) 3.92
Dairy (eggs, milk, butter) 1.76
Vegetables (leafy, beans, root crops) 1.17
Fruits (tree fruits including tropicals) 0.82
Grains and cereals 2.02
Oils and fats 4.63
Nuts 14.82
Condiments and spices 6.76
Beverages (including wine, beer, spirits) 0.44

Although it has been suggested that it is difficult to prepare a diet of natural foods that provides less than 2 mg of copper per day,(Footnote 14) which is the level considered to be adequate for normal copper metabolism,(Footnote 15) a recent review of copper requirements concluded that the modern American diet often provided less than this, in the range of 1 mg/day.(Footnote 16) Many processed foods (i.e., "fast" foods) common in North American diets are very low in copper content.(Footnote 17)

No data are available on copper concentrations in air in Canada. Nriagu calculated the average range of copper concentrations in rural and urban air to be 0.005 to 0.05 µg/m3 and 0.03 to 0.2 µg/m3, respectively,(Footnote 18) too low to be a source of concern.

Canadian Exposure

Using a value of 0.176 mg/L, the average concentration of copper consumed in drinking water as obtained from the integrated monitoring survey in Ontario, one can estimate the daily intake of copper from tap water to be 0.264 mg for an adult consuming an average of 1.5 L of water per day.

Various estimates of the copper intake from a typical Canadian diet have been made. Daily copper consumption in Vancouver in 1970 and in Toronto in 1971 was estimated to be 2.1 mg.(Footnote 19) In a cross-Canada study, it was concluded that the average individual ingested 2.2 mg of copper per day.(Footnote 20)

Assuming that ambient urban air containing copper concentrations ranging from 0.03 to 0.2 µg/m3 is inhaled by a 70-kg person breathing 20 m3 of air per day, the copper intake through inhalation would be 0.01 to 0.06 µg/kg body weight per day.

Average daily exposures from air, food, and water for a person weighing 70 kg, drinking 1.5 L of water per day, and inhaling 20 m3 of air per day are

Table 3. Average daily exposures from air, food, and water
  Exposure
Route mg/day % mg/kg body weight per day
  • Assuming maximum exposure through air.
    summarized in Table 3.
Air 0.00070-0.004 0.16 0.00001-0.00006
Food 2.200 89.14 0.0314
Water 0.264 10.70 0.00377
Total 2.468 100.00 0.0352

Analytical Methods and Treatment Technology

In the past, the most commonly employed methods for copper analysis were atomic absorption spectrometry (AAS) and atomic emission spectrometry (AES).(Footnote 21) Using these methods, the lowest detection limit was 0.001 mg/L, but a practical quantitation limit of about 0.01 mg/L was the norm. More recently, inductively coupled plasma excitation (ICP) methods, such as ICP-AES and ICP-mass spectrometry (ICP-MS), have begun to replace the older ones.(Footnote 22,Footnote 23) The detection limit for ICP-AES is 0.001 mg/L,(Footnote 23) but for ICP-MS the limit tends to vary according to the composition of the sample in question.

Treatment processes for the control of copper in water may be based on removal from the raw water supply or alteration of the water chemistry to reduce corrosivity.(Footnote 24) Copper may be removed by coagulation with aluminium or ferric salts; 98% removal was predicted at pH 8, depending on the concentration of organic complexing agents.(Footnote 25) The average copper reduction in 12 conventional water treatment plants in California and Colorado was 49%, whereas other tests found no reduction in copper after conventional treatment.(Footnote 24) Lime precipitation followed by settling was effective in copper removal; treatment of a solution with an influent concentration of 0.1 mg/L resulted in a finished concentration of less than 0.001 mg/L.(Footnote 26) More advanced treatment processes, such as reverse osmosis and distillation, are also effective in removal of copper.

Conditioning of water to prevent dissolution of copper from plumbing materials is recommended in view of the significance of this source of copper in domestic water supplies. The U.S. Environmental Protection Agency (EPA) recommends that communities whose tap water contains high copper levels should raise the pH above 8 and the alkalinity to 30 mg/L or more.(Footnote 16)

Health Considerations

Essentiality

Copper is an essential element in mammalian nutrition and is required in many enzymatic reactions. It is essential for the normal utilization of iron, because of the requirement of ferroxidase (ceruloplasmin) for iron transport. Copper deficiency (less than about 2 mg/day) is accompanied by anaemia, resulting from the inability of reticulocytes to obtain iron from transferrin and to synthesize haem from iron(III) and protoporphyrin at a normal rate.(Footnote 27) Other copper-requiring enzyme systems include monoamine oxidase enzymes, required for pigmentation and control of neurotransmitters and neuropeptides; lysyl oxidase, essential for the maintenance of connective tissue in lungs, bone, and elastin in the cardiovascular system; cytochrome c oxidase, involved in oxidative metabolism, brain functioning, haem synthesis, and phospholipid synthesis; and superoxide dismutase, required for the destruction of superoxide radicals.(Footnote 28)

The ratio of copper to other dietary components (e.g., zinc, iron, sulphate, and molybdenum) may be as important as the actual copper levels in the diet.(Footnote 29) Copper/zinc ratios may be important to the adequate metabolism of cholesterol, with low ratios resulting in hypercholesterolaemia.(Footnote 17,Footnote 30)

Severe copper deficiency has been observed in malnourished children in Peru. Symptoms included anaemia, neutropenia, and disturbances of bone formation, which responded to copper supplementation.(Footnote 31) Patients on parenteral alimentation for various medical reasons have also shown signs of copper deficiency.(Footnote 28) Experimentally induced copper deficiency in a 29-year-old male, caused by consuming a diet that contained only 0.8 mg of copper per day for 105 days, resulted in abnormal electrocardiograph values (premature ventricular beats). Similarly, cardiovascular disturbance, including a heart attack, severe tachycardia, and extrasystolic beats, resulted from administration of diets containing only 1 mg of copper per day (0.35 mg/1000-kcal diet) to 29 male volunteers.(Footnote 32) In adults, these results indicate that the observed signs of cardiovascular-related dysfunctions may be more sensitive indicators of copper deficiency than anaemia.(Footnote 28)

Metabolism

Based on studies with radioactive isotopes of copper, most copper is absorbed from the stomach and duodenum of the gastrointestinal tract. Maximum blood copper levels were observed within 1 to 3 hours following oral administration, and about 50 percent of ingested copper was absorbed.(Footnote 17) Copper absorption is proposed to occur by two mechanisms, one energy-dependent and the other enzymatic. Factors that can interfere with copper absorption include competition for binding sites with zinc, interactions with molybdenum and sulphates, chelation with phytates, and inhibition by ascorbic acid.

Copper absorbed from the gastrointestinal tract is transported rapidly to blood serum and deposited in the liver bound to metallothionein, from which it is released and incorporated into ceruloplasmin, a specific copper-transporting protein. Copper that remains in the serum is bound to albumin or amino acids or is contained in the erythrocytes. About 80 percent of the absorbed copper is bound to liver metallothionein; the remainder is incorporated into cytochrome c oxidase or sequestered by lysosomes.(Footnote 17)

The distribution of copper is affected by sex, age, and the level of copper in the diet. Brain and liver have the highest tissue levels (about one-third of the total body burden), with lesser concentrations found in the heart, spleen, kidneys, and blood. The iris and choroid of the eye have very high copper levels.(Footnote 17)

Erythrocyte copper levels are very stable, whereas plasma levels fluctuate widely in association with the synthesis and release of ceruloplasmin. Plasma copper levels during pregnancy may be two to three times levels before pregnancy, due to the increased synthesis of ceruloplasmin. The source of the extra copper appears to be the liver. Oestrogens appear to be the stimulatory agents for the release of copper from the liver, as oestrogen treatment is associated with increased plasma copper levels in both men and women. Oral contraceptives cause marked increases in serum copper levels.(Footnote 17)

Metabolic balance studies demonstrate that persons with daily intakes of 2 to 5 mg of copper per day absorbed 0.6 to 1.6 mg (32%), excreted 0.5 to 1.3 mg in the bile, passed 0.1 to 0.3 mg directly into the bowel, and excreted 0.01 to 0.06 mg in the urine.(Footnote 28) As these data indicate, urinary excretion plays a minor role in copper clearance, and the principal route of excretion is in the bile. Other minor excretory routes include saliva, sweat, menstrual flow, and excretion into the intestine from the blood.(Footnote 28)

The biological half-life for copper clearance from the body is very short (i.e., hours); therefore, copper would not tend to accumulate in the body.(Footnote 17)

Adverse Effects

Acute copper poisoning is rare in higher mammals owing to the potent emetic action of copper. In humans, acute copper toxicity has usually been associated with accidental consumption; symptoms include a metallic taste in the mouth, nausea, vomiting, epigastric pain, diarrhoea, jaundice, haemolysis, haemoglobinuria, haematuria, and oliguria. In severe cases, the stool and saliva may appear green or blue; in the terminal phases, anuria, hypotension, and coma precede death.(Footnote 17,Footnote 33)

Ingestion of more than 15 mg of copper has been reported to be toxic to humans.(Footnote 34) In a survey of human clinical case studies, 5.3 mg/day was the lowest oral dose at which local gastrointestinal irritation was seen.(Footnote 35,Footnote 36) Ingestion of gram quantities of copper sulphate resulted in death by suicide, whereas less severe effects were reported from estimated copper doses of 40 to 50 mg from ingestion of carbonated beverages in contact with copper containers.(Footnote 8)

Limited data are available on the chronic toxicity of copper. The hazard from dietary intakes of up to 5 mg/day appears to be low.(Footnote 8) Two groups are at increased risk from the toxic effects of chronic ingestion of high doses: individuals with glucose-6-phosphate (G-6P) dehydrogenase deficiencies, and individuals with Wilson's disease, an inborn error of copper metabolism in which copper accumulates in the brain, liver, and kidney.(Footnote 28) An infant who was fed water containing copper at 6.8 mg/L for 14 months was reported to have died, but it was not known whether he suffered from one of the genetic conditions mentioned above.(Footnote 8)

Wide variation has been reported in the susceptibility of different animal species to copper. Sheep appeared to be one of the most sensitive species because of a deficiency of G-6P dehydrogenase;(Footnote 8) rats were one of the least sensitive. Swine showed hypo-chromic microcytic anaemia, jaundice, and marked increases in liver and serum copper levels at the copper concentration of 750 µg/g diet. A level of 250 µg/g diet was toxic to swine unless supplementary zinc and iron were included. No toxicity was observed for animals with diets containing copper at 750 µg/g when the animals received zinc and iron supplements of 500 to 750 µg/g diet.(Footnote 28,Footnote 37)

Signs comparable to hepatic haemosiderosis developed in swine and rats with chronic dietary excesses of copper. The applicability of these data to humans was questioned, as excess copper ingestion in humans was seldom associated with hepatic haemosiderosis.(Footnote 38)

The International Agency for Research on Cancer has not evaluated copper or copper compounds for carcinogenicity. An increased incidence of granulomas in the liver and malignant lung tumours has been reported in vineyard workers in France, Portugal, and Italy who were exposed to copper sulphate sprays mixed with lime to control mildew.(Footnote 39,Footnote 40) Quantitative estimates of the levels of copper exposure could not be made from these data.(Footnote 17) The U.S. EPA has classified copper compounds in Group D--inadequate data in humans and animals.(Footnote 36)

Copper compounds were reported to be negative in microbial mutation assays.(Footnote 36) No other data were available on results of short-term in vitro or in vivo genotoxicity tests.

No data were available on teratogenic effects of copper. Copper deficiency during pregnancy was reported to result in poor fertility in sheep and cattle.(Footnote 28)

Recommended Daily Intake

The World Health Organization has recommended a daily intake of 30 µg/kg body weight per day (or 2.1 mg/day) for an adult male and 80 µg/kg body weight per day for infants.(Footnote 41) These recommendations were based on balance studies in children and adults, including studies on intakes required to equal the daily copper loss through metabolism and excretion. The recommendations for adults are similar to those (2 to 3 mg/day) of the National Academy of Sciences. Intakes as low as 5.3 mg/day have been reported to be mildly toxic, but most reports of toxicity involve intakes of 15 mg/day or more.

Other Considerations

The presence of copper in domestic water systems has caused green staining of laundry and plumbing fixtures at concentrations as low as 1.0 mg/L.(Footnote 42) Temperature, aggressive tendencies of water, and impurities in copper piping all contribute to the solvency of copper and consequently to the staining problem. Dissolved copper can also have a detrimental effect on galvanized products, as it enhances the corrosion of aluminium and zinc.

Copper in water has an unpleasant, astringent taste. The taste threshold for copper in distilled water is in the range of 2.4 to 3.2 mg/L.(Footnote 43,Footnote 44) In carbonated mineral water from the former West Germany, the taste threshold for copper was 0.8 to 1.0 mg/L,(Footnote 43) whereas it was 5 mg/L in Arkansas, USA.(Footnote 44)

Conclusions

  1. Copper is an essential and beneficial element in human metabolism. Its recommended daily intake, based on essentiality, is about 2 mg/day for adults, or 30 µg/kg body weight per day. At average concentrations, drinking water contributes approximately 11% of the daily copper requirement. Copper is generally considered to be non-toxic except at high doses, in excess of 15 mg/day.
  2. Copper in public water supplies enhances corrosion of aluminium and zinc. It also imparts an undesirable bitter taste to water. Staining of laundry and plumbing fixtures occurs at copper concentrations above 1.0 mg/L.
  3. The aesthetic objective for copper in drinking water is therefore ≤ 1.0 mg/L. This level is below the taste threshold for copper in water, is protective of health, and contributes to minimum nutritional requirements.

References

Footnote 1

Wood, G.E. Copper. In: Canadian minerals yearbook, 1975. Department of Energy, Mines and Resources, Ottawa (1976).

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Footnote 2

Massey, A.G. Copper. In: Comprehensive inorganic chemistry. Vol. 3. J.C. Bailar, Jr., H.J. Emeléus, Sir Ronald Nyholm and A.F. Trotman-Dickinson (eds.). Pergamon Press, Oxford. p. 1 (1973).

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Footnote 3

Browning, E. Toxicity of industrial metals. 2nd edition. Butterworths, London (1969).

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Footnote 4

Matheson, D.H. Water quality criteria for Great Lakes waters to be used as municipal and industrial water supplies. IWD Scientific Series No. 43, Inland Waters Directorate, Environment Canada, Burlington, Ontario (1975).

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Footnote 5

United Nations. UN statistical yearbook, 1981. Vol. 2. World metal statistics. New York, NY, March (1984).

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Footnote 6

Stiff, M.J. The chemical states of copper in polluted fresh water and a scheme of analysis for differentiating them. Water Res., 5: 585 (1971).

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Footnote 7

Cotton, F.A. and Wilkinson, G. Advanced inorganic chemistry. 3rd edition. Wiley-Interscience, Toronto (1972).

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Footnote 8

National Academy of Sciences. Drinking water and health. Vol. 1. Washington, DC (1977).

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Footnote 9

Canadian Council of Resource and Environment Ministers. Canadian water quality guidelines. Inland Waters Directorate, Environment Canada, Ottawa (1987).

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Footnote 10

Méranger, J.C., Subramanian, K. and Chalifoux, C. A national survey for cadmium, chromium, copper, lead, zinc, calcium and magnesium in Canadian drinking water supplies. Environ. Sci. Technol., 13(6): 707 (1979).

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Footnote 11

Méranger, J.C., Subramanian, K. and Chalifoux, C. Survey for cadmium, cobalt, chromium, copper, nickel, lead, zinc, calcium, and magnesium in Canadian drinking water supplies. J. Assoc. Off. Anal. Chem., 64: 44 (1981).

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Footnote 12

Maessen, O., Freedman, B. and McCurdy, R. Metal mobilization in home well water systems in Nova Scotia. J. Am. Water Works Assoc., 77: 73 (1985).

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Footnote 13

Proctor and Redfern Consulting Engineers. Unpublished report prepared for Ontario Ministry of the Environment (Hugh Graham) (1989).

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Footnote 14

Schroeder, H.A., Nason, A.P., Tipton, I.H. and Balassa, J.J. Essential trace elements in man. Copper. J. Chronic Dis., 19: 1007 (1966).

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Footnote 15

Adelstein, S.J. Metalloenzymes and myocardial infarction. I. The relation between serum copper and ceruloplasmin and its catalytic activity. N. Engl. J. Med., 255: 105 (1956).

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Footnote 16

U.S. Environmental Protection Agency. Proposed national drinking water regulations for lead and copper. Fed. Regist., 53: 31516 (1988).

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Footnote 17

U.S. Environmental Protection Agency. Ambient water quality for copper. Publ. No. PB81-117475, Office of Water Regulations and Standards, Criteria and Standards Division, Washington, DC (1980).

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Footnote 18

Nriagu, J.O. Copper in the atmosphere and precipitation. In: Copper in the environment. Part 1. Ecological cycling. J.O. Nriagu (ed.). John Wiley & Sons, New York, NY. p. 43 (1979).

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Footnote 19

Kirkpatrick, D.C. and Coffin, D.E. The trace metal content of representative Canadian diets in 1970 and 1971. J. Inst. Can. Sci. Technol. Aliment., 7: 56 (1974).

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Footnote 20

Méranger, J.C. and Coffin, D.E. The heavy metal content of a typical Canadian diet. Can. J. Public Health, 63: 53 (1972).

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Footnote 21

Department of National Health and Welfare. Guidelines for drinking water quality. Compendium of methods used in Canada for the analysis of drinking water. Ottawa (ca. 1979-80).

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Footnote 22

Ontario Ministry of the Environment. Drinking Water Method E3051A (draft). Laboratory Services Branch, Rexdale, Ontario (1992).

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Footnote 23

Environment Canada. National Water Quality Data Bank (NAQUADAT) dictionary. Data Systems Section, Water Quality Branch, Ottawa (1985).

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Footnote 24

McDonald, R. & Assoc. Guidelines for Canadian drinking water quality--applications guide: treatment options for specific constituents. Contract report prepared for Department of National Health and Welfare, Regina (1989).

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Footnote 25

Trace Inorganic Substances Research Committee. A review of solid-solution interactions and implications for the control of trace organic materials in water treatment. J. Am. Water Works Assoc., 80: 56 (1988).

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Footnote 26

Stover, E.L. and Kincannon, D.F. Contaminated groundwater treatability--a case study. J. Am. Water Works Assoc., 75: 292 (1983).

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Footnote 27

Williams, D.M., Lee, G.R. and Cartwright, G.E. Mitochondrial iron metabolism. Fed. Proc., Fed. Am. Soc. Exp. Biol., 32: 924 (1973).

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Footnote 28

Davis, G.K. and Mertz, W. Copper. In: Trace elements in human and animal nutrition. Vol. 1. 5th edition. W. Mertz (ed.). Academic Press, New York, NY (1987).

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Footnote 29

Smith, S.E. and Larson, E.J. Zinc toxicity in rats: antagonistic effects of copper and liver. J. Biol. Chem., 163: 29 (1946).

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Footnote 30

Klevay, L.M. Coronary heart disease: the zinc/copper hypothesis. Am. J. Clin. Nutr., 28: 764 (1975).

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Footnote 31

Hambidge, K.M. and Nichols, B.F., Jr. (eds.). Zinc and copper in clinical medicine. Spectrum Press, New York, NY (1978).

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Footnote 32

Reiser, S., Smith, J.C., Mertz, W., Holbrook, J.T., Scholfield, D.J., Powell, A.S., Canfield, W.K. and Canary, J.J. Indices of copper status in humans consuming a typical American diet containing either fructose or starch. Am. J. Clin. Nutr., 42: 242 (1985).

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Footnote 33

Piscator, M. Copper. In: Handbook on the toxicology of metals. L. Friberg, G.F. Nordberg and V.B. Vouk (eds.). Elsevier/North-Holland Biomedical Press, Amsterdam. p. 411 (1979).

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Footnote 34

Burch, R.E., Hahn, H.K.J. and Sullivan, J.F. Newer aspects of the roles of zinc, manganese and copper in human nutrition. Clin. Chem., 21: 501 (1975).

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Footnote 35

Chuttani, H.R. Acute copper sulphate poisoning. Am. J. Med., 39: 849 (1965).

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Footnote 36

U.S. Environmental Protection Agency. National primary drinking water regulations; synthetic organic chemicals, inorganic chemicals and microorganisms; proposed rule. Fed. Regist., 50(219): 46387 (1985).

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Footnote 37

Suttle, N.F. and Mills, C.F. Studies of the toxicity of copper to pigs. 2. Effect of protein source and other dietary components on the response to high and moderate intakes of copper. Br. J. Nutr., 20: 149 (1966).

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Footnote 38

Mallory, F.B. and Parker, F., Jr. Experimental copper poisoning. Am. J. Pathol., 7: 351 (1931).

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Footnote 39

Pimental, J.C. and Menezes, A.P. Liver granulomes containing copper in vineyards sprayer's lung. A new etiology of hepatic granulomatosis. Am. Rev. Respir. Dis., 111: 189 (1975).

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Footnote 40

Villar, T.G. Vineyard sprayer's lung: clinical aspects. Am. Rev. Respir. Dis., 110: 545 (1974).

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Footnote 41

World Health Organization. Trace elements in human nutrition; a report of a WHO Expert Committee. WHO Technical Report Series 532, Geneva. p. 70 (1973).

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Footnote 42

World Health Organization. Guidelines for drinking-water quality. Vol. 2. Geneva (1984).

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Footnote 43

Beguin-Bruhin, Y., Escher, F. and Solms, J. Threshold concentration of copper in drinking water. Lebensm.-Wiss. Technol., 16: 22 (1983).

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Footnote 44

Sims, R.A. and Raible, R.W. Causes of localized copper corrosion in drinking water supplies. Publ. No. PB 83-222448, Office of Water Research and Technology, U.S. Environmental Protection Agency, Washington, DC (1983).

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