Implications of Hypozincemia (Plasma Zinc 45 μg/dL)
The low plasma zinc level of 45 μg/dL (normal range 56-134 μg/dL) indicates significant hypozincemia that requires treatment with zinc supplementation to prevent complications related to zinc deficiency.
Clinical Significance of Hypozincemia
- Hypozincemia is associated with increased susceptibility to infections, as zinc plays a critical role in immune function 1
- Low zinc levels can lead to dysgeusia (taste disturbances), which may be an early symptom of zinc deficiency 2
- Hypozincemia is commonly observed in patients with chronic conditions such as chronic renal failure and chronic hepatitis C 3, 4
- During acute infections, plasma zinc levels decrease as part of the acute phase response, which may not reflect true zinc deficiency 5
Potential Causes of Hypozincemia
- Acute infections can cause transient hypozincemia due to the acute phase response 5
- Chronic liver disease, particularly hepatitis C, is associated with hypozincemia due to decreased albumin production 4
- Chronic kidney disease can lead to hypozincemia through increased urinary zinc excretion 3
- Malnutrition or inadequate dietary zinc intake 2
- Medications that chelate zinc or increase zinc excretion 5
Clinical Manifestations of Zinc Deficiency
- Taste disturbances (dysgeusia) - often an early and reversible symptom 2
- Impaired wound healing 5
- Increased susceptibility to infections 1
- Skin manifestations (dermatitis, hair loss) 2
- Neurological symptoms (irritability, lethargy) 3
Diagnostic Considerations
- Plasma zinc levels may be falsely low during acute infections due to the acute phase response 5
- Albumin-corrected zinc levels may provide a more accurate assessment of zinc status in patients with acute infections 5
- Serum albumin levels should be measured concurrently, as approximately 60% of serum zinc is bound to albumin 4
- Consider measuring other markers of inflammation (CRP, ferritin) to assess for acute phase response 5
Treatment Recommendations
- Oral zinc supplementation is the primary treatment for hypozincemia 2
- Zinc acetate hydrate (50 mg/day of elemental zinc) has been shown to be effective in treating hypozincemia-induced dysgeusia 2
- Treatment duration of at least 12-24 weeks may be necessary to normalize zinc levels and improve symptoms 2
- Monitor serum zinc levels during treatment to ensure normalization 4
- Monitor serum copper levels during zinc supplementation, as high-dose zinc can interfere with copper absorption 2
Monitoring and Follow-up
- Recheck plasma zinc levels after 12 weeks of supplementation 2
- Monitor for improvement in clinical symptoms, particularly taste disturbances 2
- Assess for potential side effects of zinc supplementation (gastric irritation, copper deficiency with prolonged high-dose therapy) 2
- Consider long-term supplementation in patients with chronic conditions that predispose to zinc deficiency 4
Special Considerations
- In patients with acute infections, consider repeating zinc measurement after resolution of the infection 5
- In patients with chronic liver disease, zinc supplementation may improve liver function parameters 4
- In patients with chronic kidney disease, higher doses of zinc may be required due to increased urinary losses 3
- Albumin-corrected zinc levels may provide a more accurate assessment of zinc status in patients with hypoalbuminemia 5