What is the acute management of a zinc overdose in an adult who ingested more than 20 mg/kg within the past hour?

Zinc overdose should be treated as an acute toxic ingestion and managed promptly; the first step is to stop any further zinc exposure and obtain a thorough history of the amount, formulation (e.g., tablets, lozenges, syrup) and time since ingestion. In an adult who presents within one hour of a likely significant dose (generally > 20 mg/kg), consider gastric lavage if the airway is protected and the patient is not at risk for aspiration, followed by administration of activated charcoal (1 g/kg, up to 50 g) to bind any remaining zinc in the gastrointestinal tract. Supportive care is the mainstay: give intravenous fluids to maintain hydration, treat nausea and vomiting with antiemetics, and monitor electrolytes. Because zinc can cause direct irritation, patients often have abdominal pain, nausea, vomiting and possible diarrhea; these symptoms should be addressed symptomatically. Obtain serum zinc level if available, but do not delay treatment while awaiting results. Monitor complete blood count and copper levels, as acute zinc toxicity can precipitate a rapid drop in copper and lead to anemia or neutropenia; if copper deficiency develops, supplement copper orally (e.g., copper gluconate 2 mg daily) after the acute phase. In severe cases with persistent vomiting, consider repeated doses of activated charcoal every 4–6 hours. For pediatric patients, the toxic threshold is lower (approximately 10 mg/kg); the same principles apply, but dosing of charcoal and supportive measures should be weight‑adjusted. There is no specific antidote for zinc; therefore, management focuses on decontamination, symptomatic treatment, and monitoring for complications such as renal impairment, electrolyte disturbances, and secondary copper deficiency. If any signs of respiratory distress, altered mental status, or hemodynamic instability develop, initiate advanced life support measures and consider admission to an intensive care unit for close observation. All patients with suspected zinc overdose should be advised to seek immediate medical care, and preventive counseling on proper use of zinc supplements should be provided after recovery.