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# Zinc
## Overview
Zinc is an essential trace element involved in numerous enzymatic processes, protein synthesis, and wound healing. "DT" typically refers to dispersible tablets used primarily for oral rehydration protocols.
## Primary Indications
* Adjunct to Oral Rehydration Salts (ORS) in acute diarrhea (WHO/UNICEF recommendation).
* Treatment of zinc deficiency (e.g., malabsorption, chronic diarrhea, parenteral nutrition).
* Wilson’s disease (as zinc acetate).
## Adult Dosing
* **Acute Diarrhea:** 20 mg elemental zinc daily for 10–14 days.
* **Zinc Deficiency:** 25–50 mg elemental zinc daily.
* **Maximum:** Tolerable Upper Intake Level (UL) for adults is 40 mg/day (prolonged high-dose therapy should be monitored to avoid copper deficiency).
## Pediatric Dosing
* **Acute Diarrhea (WHO Guidelines):**
* **Infants <6 months:** 10 mg elemental zinc once daily for 10–14 days.
* **Children ≥6 months:** 20 mg elemental zinc once daily for 10–14 days.
* **Zinc Deficiency:** 0.5–1 mg/kg/day elemental zinc, divided into 1-3 doses.
## Dose Adjustments
* **Renal Impairment:** Reduce frequency; zinc is primarily excreted via the GI tract, but accumulation may occur with severe impairment.
* **Hepatic Impairment:** Use with caution; monitor for potential accumulation.
## Contraindications
* Hypersensitivity to zinc salts.
* Acute supplementation should not replace standard oral rehydration and electrolyte replacement.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, epigastric pain, metallic taste, diarrhea.
* **Long-term high-dose:** Copper deficiency (manifesting as anemia, neutropenia, neurological symptoms) due to zinc-induced intestinal metallothionein production which blocks copper absorption.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Zinc forms insoluble chelates; separate dosing by at least 2–4 hours (zinc before or after).
* **Penicillamine:** Zinc decreases absorption of penicillamine.
* **Iron Supplements:** Concurrent high-dose iron may compete with zinc for absorption; separate by 2 hours.
## Monitoring
* Serum zinc levels (if on chronic high-dose therapy).
* Copper levels and hematologic parameters (CBC) during long-term use to rule out induced copper deficiency.
* Assess for gastrointestinal tolerance.
## Clinical Pearls
* **Administration:** Dispersible tablets (DT) should be dissolved in a small amount of liquid (e.g., water or breast milk) immediately before administration.
* **Absorption:** Presence of phytates (found in fiber/grains) and calcium can decrease zinc absorption.
* **Dosing note:** Ensure the prescribed dose is for *elemental* zinc, not the salt weight (e.g., Zinc Sulfate 220 mg contains ~50 mg elemental zinc).
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*Disclaimer: This information is for educational purposes only. Dosing protocols can vary by region and institutional formulary. Always verify current prescribing information, local clinical guidelines, and specific salt-to-elemental zinc conversion ratios before prescribing or administering.*
