DESCRIPTION: | SIGNS AND SYMPTOMS: | CAUSES: | DIFFERENTIAL DIAGNOSIS: | LABORATORY: | PATHOLOGICAL FINDINGS: | IMAGING: | TREATMENT | DRUG(S) OF CHOICE | PRECAUTIONS: | ALTERNATIVE DRUGS: | PATIENT MONITORING: | POSSIBLE COMPLICATIONS: | MISCELLANEOUS
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
* 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
* 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
* High milk consumption
* Low socioeconomic status
DIAGNOSIS
* Congenital dwarfism
* Failure to thrive in infants
* Primary hypogonadism
* Mental retardation
* 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
DIAGNOSTIC PROCEDURES: TOP : N/A
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
* 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.
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.