From the Guidelines
Zinc and calcium deficiencies can be effectively managed with targeted supplements and dietary changes, prioritizing treatments that address morbidity, mortality, and quality of life. Zinc deficiency symptoms include impaired immune function, delayed wound healing, hair loss, diarrhea, loss of appetite, and reduced sense of taste and smell, as noted in the espen micronutrient guideline 1. In severe cases, skin lesions and growth retardation may occur. Treatment typically involves zinc supplements at 25-50 mg elemental zinc daily for adults for 2-3 months, with maintenance doses of 15-30 mg daily thereafter, although specific recommendations can vary based on the underlying cause and severity of the deficiency, such as the 60 mg Zn 2 times/d suggested for treatment in certain cases 1. Calcium deficiency manifests as muscle cramps, numbness and tingling in the fingers, abnormal heart rhythms, and in chronic cases, osteoporosis and increased fracture risk. Treatment requires calcium supplements, commonly calcium carbonate or calcium citrate, at 1000-1200 mg elemental calcium daily for adults, divided into 500-600 mg doses for better absorption, as recommended for adult bariatric surgery patients 1. Vitamin D (800-1000 IU daily) should accompany calcium supplementation as it enhances absorption. Dietary changes are also important for both deficiencies - incorporating zinc-rich foods like oysters, red meat, poultry, beans, and nuts, and calcium-rich foods such as dairy products, leafy greens, and fortified foods. Underlying causes of deficiencies should be addressed, and excessive supplementation avoided as it can cause adverse effects including nausea, vomiting, and interference with absorption of other nutrients. Key considerations include:
- Identifying and managing underlying causes of zinc and calcium deficiencies
- Implementing targeted supplementation regimens
- Promoting dietary changes to enhance zinc and calcium intake
- Monitoring for potential adverse effects of supplementation and adjusting treatment plans as necessary
- Prioritizing patient education on the importance of balanced nutrition and the role of zinc and calcium in maintaining overall health.
From the FDA Drug Label
Maternal hypocalcemia can result in an increased rate of spontaneous abortion, premature and dysfunctional labor, and possibly preeclampsia Fetal/Neonatal adverse reactions Infants born to mothers with hypocalcemia can have associated fetal and neonatal hyperparathyroidism, which in turn can cause fetal and neonatal skeletal demineralization, subperiosteal bone resorption, osteitis fibrosa cystica and neonatal seizures Symptoms of hypercalcemia typically develop when the total serum calcium concentration is ≥12 mg/dL. Neurologic symptoms include depression, weakness, fatigue, and confusion at lower levels, with patients experiencing hallucinations, disorientation, hypotonicity, seizures, and coma.
The symptoms of calcium deficiency include:
- Spontaneous abortion
- Premature and dysfunctional labor
- Preeclampsia
- Fetal and neonatal hyperparathyroidism
- Skeletal demineralization
- Subperiosteal bone resorption
- Osteitis fibrosa cystica
- Neonatal seizures
The symptoms of calcium excess include:
- Depression
- Weakness
- Fatigue
- Confusion
- Hallucinations
- Disorientation
- Hypotonicity
- Seizures
- Coma
There is no information about zinc deficiency symptoms in the provided drug labels 2 2.
From the Research
Zinc Deficiency Symptoms
- Impaired growth and development 3
- Dermatitis, diarrhea, and other skin lesions 4
- Impaired immune function and wound healing 4, 5
- Failure to thrive, skin rash, and impaired wound healing 5
- Susceptibility to infection and poor growth 5
- Abnormal water balance, taste abnormalities, and decreased food intake 3
- Impaired reproduction and teratogenesis 3
- Depressed immunity 3
Calcium Deficiency Symptoms
- Impaired bone growth and development 6
- Osteoporosis and increased risk of fractures 6
- Weakened immune system 7
- Impaired muscle and nerve function 3
Treatment Options
- Zinc supplementation to prevent and treat zinc deficiency 4, 5
- Dietary diversification and food and agricultural interventions to reduce calcium and zinc deficiency risks 7
- Fortification, crop breeding, and use of micronutrient fertilisers to increase calcium and zinc intake 7
- Parenteral nutrition with generous zinc provision to prevent zinc deficiency in patients receiving PN 5
- Zinc compounds, such as beta-Alanyl-L-histidinato zinc (AHZ) and zinc acexamate, as potential therapeutic agents for osteoporosis 6