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Zinc deficiency :

DESCRIPTION: | SIGNS AND SYMPTOMS: | CAUSES: | DIFFERENTIAL DIAGNOSIS: | LABORATORY: | PATHOLOGICAL FINDINGS: | IMAGING: | TREATMENT | DRUG(S) OF CHOICE | PRECAUTIONS: | ALTERNATIVE DRUGS: | PATIENT MONITORING: | POSSIBLE COMPLICATIONS: | MISCELLANEOUS

BASICS TOP

DESCRIPTION: TOP : Constellation of growth retardation, hypogonadism, cell mediated immune dysfunction, and skin changes related to decreased zinc

System(s) affected: Endocrine/Metabolic, Skin/Exocrine, Nervous

Genetics: Usually acquired, but rarely acrodermatitis enteropathica (autosomal recessive) and associated with sickle cell anemia (autosomal recessive)

Incidence/Prevalence in USA: Unknown

Predominant age: All ages, most often adolescent

Predominant sex: Male = Female

SIGNS AND SYMPTOMS: TOP :

* Mild deficiency

>> Hypogeusia

>> Decreased dark adaptation

>> Decreased lean body mass

* Moderate deficiency

>> All of the above

>> Diarrhea

>> Growth retardation

>> Hypogonadism (especially male)

>> Mental lethargy

>> Anergy

>> Rough skin

>> Delayed wound healing

>> Glucose intolerance

>> Impaired cell mediated immunity

* Severe deficiency

>> All of the above

>> Bullous pustular dermatitis

>> Weight loss

>> Dwarfism

>> Emotional instability

>> Tremors

>> Ataxia

>> Alopecia

>> Death

CAUSES: TOP

* Increased requirements

>> Pregnancy

>> Lactation

>> Rapid growth phase of childhood

>> Burns

>> Major trauma

* Increased losses

>> Diabetes

>> Cirrhosis

>> Renal disease

>> Malabsorption states, e.g., inflammatory bowel diseases

>> Sickle cell anemia

* Decreased absorption

>> Acrodermatitis enteropathica, an autosomal recessive deficiency in the enzyme required for intestinal absorption

>> Geophagia

>> Chelating agents

>> Parasitism

>> Diet high in phytates

* Insufficient dietary intake

>> Vegetarianism

>> Parenteral hyperalimentation without supplementation

>> Breast feeding

>> Suboptimal zinc conditions in diet (rare)

>> Alcoholism

RISK FACTORS: TOP :

* High milk consumption

* Low socioeconomic status

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS: TOP :

* Congenital dwarfism

* Failure to thrive in infants

* Primary hypogonadism

* Mental retardation

LABORATORY: TOP :

* Plasma zinc levels decreased (in moderate to severe zinc deficiency)

* Erythrocyte or leukocyte zinc levels more adequately assess tissue stores, but these are more costly and not widely available

* Hair or fingernail zinc levels not useful

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS: TOP : N/A

SPECIAL TESTS: N/A

IMAGING: TOP : N/A

DIAGNOSTIC PROCEDURES: TOP : N/A

TREATMENT: TOP

APPROPRIATE HEALTH CARE: Outpatient

GENERAL MEASURES: TOP : N/A

SURGICAL MEASURES: N/A

ACTIVITY: Full activity

DIET:

* Balanced omnivorous diet

* Avoid excessive intake of foods with high phytate content, (e.g., cereals)

PATIENT EDUCATION: Dietary consultation

MEDICATIONS

DRUGS OF CHOICE: TOP :

* Zinc gluconate or zinc sulfate 25-50 mg po qd for 6-9 months

* 4-6 mg of elemental zinc qd added to hyperalimentation in adult patient, may increase to 12 mg qd if suspect ongoing heavy zinc losses, e.g., burns or major trauma

* In pediatric patients, 0.02-0.04 mg zinc/kg/day in hyperalimentation

* Prenatal vitamins with minerals during pregnancy and lactation to prevent deficiency

Contraindications: None

PRECAUTIONS: TOP : Avoid large (> 20 mg elemental zinc) parenteral doses

Significant possible interactions: N/A

ALTERNATIVE DRUGS: TOP : N/A

FOLLOWUP

PATIENT MONITORING: TOP : Clinical status such as improved outlook, weight gain, resolution of symptoms

PREVENTION/AVOIDANCE:

* Adequate diet

* Supplementation when indicated (see Medications)

POSSIBLE COMPLICATIONS: TOP : N/A

EXPECTED COURSE AND PROGNOSIS: Immediate improvement in clinical status. Full resolution of signs and symptoms.

MISCELLANEOUS TOP

ASSOCIATED CONDITIONS:

* Sickle cell anemia

* Pregnancy and lactation

* Alcoholism

* Malabsorption

* Parenteral hyperalimentation

* In the older patient, diabetes, cirrhosis, those taking diuretics

AGE-RELATED FACTORS:

Pediatric: Zinc deficiency may cause failure to thrive, impair growth and development of secondary sexual characteristics

Geriatric:

* Zinc deficiency may cause poor night vision leading to falls; poor wound healing or chronic skin ulcer; loss of taste which may cause worsening nutrition

* Elderly persons living in institutions may have low zinc intake

Others: N/A

PREGNANCY: Requirements increase; deficiency may cause spontaneous abortion, inadequate weight gain

SYNONYMS: N/A

ICD-9-CM:

269.3

IMAGES:

Zinc deficiency

Acrodermatitis enteropathica

Acrodermatitis enteropathica

SEE ALSO:

* Alcoholism

* Acrodermatitis enteropathica

* Failure to thrive (FTT)

* Anemia, sickle cell

OTHER NOTES: N/A

ABBREVIATIONS: N/A

REFERENCES:

* Tasman-Jones C: Disturbances of trace mineral metabolism. In: Wyngaarden JB, et al, eds. Cecil Textbook of Medicine. 19th Ed. Philadelphia, W.B. Saunders Co., 1992

* Ronaghy H: World Review Nutr. Diet 1987:54

Author(s):

Clyde L. Harris, MD

Copyright - Williams & Wilkins, 1997.

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