II. Epidemiology
- Associated with 1.8 million deaths per year in malnourished persons worldwide
- Zinc Deficiency is estimated to affect 30% of the world population
III. Pathophysiology
- See Zinc
IV. Symptoms
- Erectile Dysfunction
- Diarrhea
- Glossitis
- Photophobia
- Decreased appetite
- Irritability
V. Signs
- Growth retardation (especially head growth)
- Delayed Puberty
- Hypogonadism
- Conjunctivitis
- Alopecia
- Perioral Facial Rash
- U-Shaped pattern involving the cheeks and chin (but spares the upper lip)
- Sharply demarcated
- May appear similar to Impetigo
-
Diaper Rash
- Symmetrical excoriated rash on the buttocks, perineum, and perianal regions
-
Nail Dystrophy
- Soft, Dystrophic Nails
- Paronychia
VI. Associated Conditions
- Autusm
- Attention Deficit Disorder
VII. Causes
- Acrodermatitis Enteropathica
- Autosomal Recessive mutation decreases zinc uptake and transport
- Results in zinc malabsorption syndrome (esp. at the small intestinal mucosa)
- Presents in infants weaned from Breast Milk
- Human Breast Milk contains adequate zinc to overcome transport mutation
-
Malnutrition
- Developing countries
- Alcoholism
- Celiac Sprue
- Cirrhosis
- Crohn Disease
- Gastric Bypass
- Prolonged intravenous feeding
- Short bowel syndrome
- Vegan diet
- Pregnancy and Lactation
- Sickle Cell Disease
- Critically ill children (associated with organ failure)
VIII. Labs
- Serum zinc levels are not a reliable measure of zinc stores
IX. Diagnosis
- Zinc Deficiency is a clinical diagnosis rather than a lab diagnosis
- Base diagnosis on symptoms, signs, risk factors and overall Malnutrition
X. Management
- See Zinc for RDA levels
- Acrodermatitis Enteropathica (zinc uptake and transport disorder)
- Lifelong Zinc supplementation: 3 mg/kg/day of elemental zinc
- Dosing is high enough to overcome zinc transport defect
- Other Zinc Deficiency
- Elemental Zinc 0.5 to 1 mg/kg/day for 6 months or until symptoms resolve
- Typically dosed at 2-3x the RDA in mild deficiency (up to 4-5x in severe deficiency)