What is the recommended treatment for zinc deficiency?

Treatment of Zinc Deficiency

For acquired zinc deficiency in adults, administer 0.5-1 mg/kg per day of elemental zinc orally for 3-4 months, preferentially using organic zinc compounds (zinc gluconate, zinc histidinate, or zinc orotate) rather than inorganic forms like zinc sulfate due to superior tolerability. 1

Dosing by Clinical Scenario

Standard Acquired Zinc Deficiency

• Oral dosing: 0.5-1 mg/kg per day of elemental zinc for 3-4 months 1
• For a 50 kg adult, this translates to 25-50 mg elemental zinc daily 2
• For a 60 kg adult, this translates to 30-60 mg elemental zinc daily 2

Parenteral Nutrition with GI Losses

• IV dosing: Up to 12 mg per day for patients with fistulae, stomas, or diarrhea while nil per mouth 1
• Continue supplementation for as long as gastrointestinal losses persist 1

Major Burns (>20% BSA)

• IV dosing: 30-35 mg/day for 2-3 weeks due to exudative losses 1

Acrodermatitis Enteropathica (Genetic Disorder)

• Lifelong oral dosing: 3 mg/kg per day of elemental zinc 1
• Adjust dosage according to plasma or serum zinc levels 1

Formulation Selection

Organic zinc compounds demonstrate significantly better tolerability than inorganic forms: 1

• Preferred (organic): Zinc gluconate, zinc histidinate, zinc orotate 1
• Less preferred (inorganic): Zinc sulfate, zinc chloride 1

Clinical absorption studies support this hierarchy: zinc glycinate shows 43.4% higher bioavailability compared to zinc gluconate 3, and zinc citrate demonstrates comparable absorption to zinc gluconate (61.3% vs 60.9%), both significantly superior to zinc oxide (49.9%) 4. However, the ESPEN guideline specifically recommends the organic compounds listed above 1.

Monitoring Requirements

Initial Assessment

• Measure plasma zinc to confirm clinical deficiency 1
• Simultaneously measure CRP and albumin for proper interpretation, as inflammation and hypoalbuminemia affect zinc levels 1

Follow-up Monitoring

• Recheck zinc levels after 3 months of supplementation 1
• Monitor copper levels concurrently, as zinc supplementation can induce copper deficiency 1, 5
• If both zinc and copper are low, consider two multivitamin tablets daily (e.g., Forceval) for 3 months 1

Ongoing Surveillance for High-Risk Patients

• Patients on long-term parenteral nutrition: every 6-12 months 1
• Patients with increased GI/skin losses: at initiation of PN and as required 1

Critical Safety Considerations

Copper Deficiency Risk

• Maintain zinc-to-copper ratio of 8-15 mg zinc to 1 mg copper when supplementing both 1, 2
• High-dose zinc (approximately 10 times the recommended 3 mg/day IV dose) taken for months to years can cause copper deficiency 5
• Copper deficiency complications include anemia, leukopenia, thrombocytopenia, myeloneuropathy, and nephrotic-range proteinuria 5
• If copper deficiency develops, interrupt zinc treatment and check zinc, copper, and ceruloplasmin levels 5

Zinc Toxicity

• Symptoms appear when ingestion exceeds 1-2 grams 1, 2, 6
• Acute toxicity treatment: antiemetics, fluids, proton pump inhibitors or H2-blockers 1
• Chelation with calcium disodium EDTA may be required for severe acute toxicity 1, 6
• Chronic toxicity: treat primarily with copper sulfate; chelation may be needed in severe cases 1

Aluminum Toxicity (Parenteral Formulations)

• Zinc sulfate injection contains aluminum that may accumulate with prolonged use, especially in patients with impaired kidney function 5
• Preterm infants are at particular risk due to immature kidneys 5
• Total daily aluminum exposure from all parenteral sources should not exceed 5 mcg/kg/day 5

Hypersensitivity Reactions

• Rare hypersensitivity reactions reported with zinc-containing products, including injection site reactions, urticaria, facial swelling, and dyspnea 5
• If hypersensitivity occurs, discontinue zinc and initiate appropriate medical treatment 5

Special Populations at Risk

High-Risk Groups Requiring Screening

• Infants, children, adolescents, pregnant and lactating women (increased requirements) 1
• Eating disorders (anorexia nervosa, bulimia) 1, 2
• Vegetarians and vegans 1
• Short bowel syndrome, bariatric surgery, cystic fibrosis 1
• Chronic pancreatitis, inflammatory bowel disease 1
• Enterostomy or enterocutaneous fistula 1
• Burns, trauma, sepsis (hypercatabolic states) 1
• Renal disease, dialysis, alcoholism 1
• Chronic parenteral or enteral nutrition 1

Cystic Fibrosis Patients

• Supplement zinc for those at risk of insufficiency (growth retardation, increased infections, delayed sexual maturation, eye problems, anorexia) 1
• Pancreatic enzyme replacement therapy can improve zinc absorption 1
• Administer in divided doses for better tolerability 1