What is the recommended treatment for hypozincemia (low zinc levels)?

Treatment of Hypozincemia (Low Zinc Levels)

For patients with hypozincemia, treatment with oral zinc supplementation at a dose of 0.5-1 mg/kg/day of elemental zinc for 3-4 months is recommended, with organic compounds such as zinc gluconate, zinc histidinate, or zinc orotate being better tolerated than inorganic zinc salts. 1

Diagnosis and Assessment

Before initiating treatment, it's important to:

• Confirm zinc deficiency through plasma zinc measurement
• Obtain simultaneous CRP and albumin levels for proper interpretation 1
• Check copper levels, as zinc supplementation can affect copper absorption 1
• Identify underlying causes of zinc deficiency:
  • Inadequate dietary intake
  • Malabsorption (bariatric surgery, short bowel syndrome, IBD)
  • Increased losses (enterostomy, fistulas, diarrhea)
  • Increased requirements (pregnancy, burns, trauma)

Treatment Protocol

Mild Zinc Deficiency

• Consider prescribing a multivitamin supplement like Forceval (two tablets daily) for 3 months 1
• Recheck zinc levels after 3 months

Moderate to Severe Zinc Deficiency

• Oral supplementation with 0.5-1 mg/kg/day of elemental zinc for 3-4 months 1
• Preferred forms: zinc gluconate, zinc histidinate, or zinc orotate (better tolerated) 1
• For severe deficiency with normal/borderline copper levels: high-dose zinc supplement for 3 months 1
• Recheck levels after 3 months; if no improvement or copper levels fall, refer for specialist advice 1

Special Situations

Patients with gastrointestinal losses:

• For patients on parenteral nutrition with GI losses (fistulae, stomas, diarrhea): IV zinc up to 12 mg/day while NPO 1
• Continue supplementation as long as GI losses persist

Burn patients:

• For major burns >20% BSA: 30-35 mg/day IV for 2-3 weeks 1

Acrodermatitis enteropathica:

• Life-long oral intake of 3 mg/kg/day of elemental zinc 1
• Adjust dosage according to plasma zinc levels

Monitoring

• Recheck zinc levels after 3 months of treatment 1
• Monitor copper levels during zinc supplementation 1
• Maintain a ratio of 8-15 mg zinc to 1 mg copper when giving additional zinc and copper 1
• For long-term supplementation, check zinc levels every 6-12 months 1

Important Considerations and Pitfalls

1. Copper deficiency risk: High-dose zinc (approximately 10 times recommended dosage) taken over extended periods can cause copper deficiency, leading to anemia, leukopenia, thrombocytopenia, and neurological complications 2

2. Balance with copper: Always check both zinc and copper levels when considering zinc replacement 1

3. Hypersensitivity reactions: Discontinue zinc if hypersensitivity reactions occur 2

4. Clinical effectiveness: Zinc supplementation has shown high efficacy rates (83%) for various conditions including pressure ulcers (96.2%), stomatitis (87.5%), and taste disorders (87.4%) 3

5. Form selection: Organic zinc compounds show better tolerability than inorganic zinc sulfate and zinc chloride 1

6. Dose adjustment: Zinc supplementation produces dose-dependent increases in serum zinc levels, regardless of underlying liver disease 4

By following this structured approach to zinc supplementation based on severity of deficiency and patient-specific factors, clinicians can effectively treat hypozincemia while minimizing potential adverse effects.