Zinc (Zn) is contained mainly in bones, teeth, hair, skin, liver, muscle, leukocytes, and testes. Zinc is a component of several hundred enzymes, including many nicotinamide adenine dinucleotide (NADH) dehydrogenases, RNA and DNA polymerases, and DNA transcription factors as well as alkaline phosphatase, superoxide dismutase, and carbonic anhydrase.
A diet high in fiber and phytate (eg, in whole-grain bread) reduces zinc absorption.
(See also Overview of Mineral Deficiency and Toxicity Overview of Minerals Six macrominerals are required by people in gram amounts. Four cations: Sodium, potassium, calcium, and magnesium Two accompanying anions: Chloride and phosphorus Daily requirements range from... read more .)
Dietary deficiency is unlikely in healthy persons. Secondary zinc deficiency can develop in the following:
Patients taking diuretics
Patients with diabetes mellitus Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , sickle cell disease Sickle Cell Disease Sickle cell disease (a hemoglobinopathy) causes a chronic hemolytic anemia occurring almost exclusively in people with African ancestry. It is caused by homozygous inheritance of genes for hemoglobin... read more , chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more , liver disease Evaluation of the Patient With a Liver Disorder History and physical examination often suggest a cause of potential liver disorders and narrow the scope of testing for hepatic and biliary disorders. Various symptoms may develop, but few are... read more , alcohol use disorder Alcohol Use Disorder and Rehabilitation Alcohol use disorder involves a pattern of alcohol use that typically includes craving and manifestations of tolerance and/or withdrawal along with adverse psychosocial consequences. Alcoholism... read more , or malabsorption Overview of Malabsorption Malabsorption is inadequate assimilation of dietary substances due to defects in digestion, absorption, or transport. Malabsorption can affect macronutrients (eg, proteins, carbohydrates, fats)... read more , and following weight loss surgery.
Patients with stressful severe acute conditions (eg, sepsis, burns, head injury)
Older institutionalized and homebound patients (common)
Maternal zinc deficiency may cause fetal malformations and low birth weight.
Zinc deficiency in children causes impaired growth, impaired taste (hypogeusia), delayed sexual maturation, and hypogonadism. In children or adults, manifestations also include alopecia, impaired immunity, anorexia, dermatitis, night blindness, anemia, lethargy, and impaired wound healing.
Zinc deficiency should be suspected in undernourished patients with typical symptoms or signs. However, because many of the symptoms and signs are nonspecific, clinical diagnosis of mild zinc deficiency is difficult. Biotin, riboflavin, and essential fatty acid deficiencies may resemble zinc deficiency. Laboratory diagnosis is also difficult, requiring special collection techniques. Low albumin levels, common in zinc deficiency, make serum zinc levels difficult to interpret; urine zinc levels are unreliable for acute deficiency, as are hair zinc levels. If available, isotope studies can measure zinc status more accurately.
Treatment of zinc deficiency consists of elemental zinc 1 to 3 mg/kg orally once a day until symptoms and signs resolve.
Acrodermatitis enteropathica (a rare, once fatal autosomal recessive disorder) causes malabsorption of zinc. Psoriasiform dermatitis develops around the eyes, nose, and mouth; on the buttocks and perineum; and in an acral distribution. The disorder also causes hair loss, paronychia, impaired immunity, recurrent infection, impaired growth, and diarrhea. Symptoms and signs usually develop after infants are weaned from breast milk. In such cases, doctors suspect acrodermatitis enteropathica. If this diagnosis is correct, elemental zinc1 to 3 mg once a day orally usually results in complete remission.
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