Saturday, January 01, 2011
Zinc deficiency may be seen in infants (hereditary or acquired)
or adults (acquired). Some breast-fed infants, especially if born
prematurely, may develop acrodermatitis enteropathica (AE) due to
zinc deficiency in the mother's breast milk. These children improve
when given standard formula with zinc, and may not require
supplementation with zinc. Acquired zinc deficiency is seen in the
postoperative period, in pregnancy, in patients with impaired zinc
consumption, and in alcoholism. Zinc deficiency may result in
typical dermatitis as well as in nonhealing ulcers and recalcitrant
infections. Secondary oral candidiasis (thrush) often complicates
AE, and may need to be treated simultaneously. Because zinc
deficiency causes AE, the therapeutic strategy is to replace
- Prescribe oral zinc sulfate 220 mg two or three times a day
with meals or fruit juice for children. In adults, 220 mg once or
twice daily is usually adequate. (Children with hereditary AE have
poor absorption and require higher oral doses than adults with
acquired AE). Response begins to occur within days.
- Prescribe oral nystatin suspension or troches for
Candida superinfections and to patients whose oral lesions
are responding slowly to zinc supplementation alone.
Some cases of AE do not clear completely with oral zinc sulfate.
Order a zinc level to confirm defective absorption. Parenteral zinc
supplementation at doses of 0.2 to 0.3 mg/kg per day can be
Hyperzincemia, with zinc toxicity, can result from acute or
prolonged overdosing of zinc. Dosages should be adjusted based upon
regular (1-2 week) assessment of fasting plasma zinc levels (ie,
before the next oral dose).