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# Zinc
## Overview
Zinc is an essential trace element involved in numerous enzymatic processes, protein synthesis, wound healing, and immune function. It is commonly administered as zinc gluconate, sulfate, or acetate. Elemental zinc content varies by salt form; clinicians must ensure the prescribed dose refers to **elemental zinc**.
## Primary Indications
* Treatment and prevention of zinc deficiency.
* Adjunctive therapy for diarrhea (World Health Organization recommendation).
* Wilson disease (zinc acetate).
* Maintenance therapy in parenteral nutrition.
## Adult Dosing
* **Zinc Deficiency:** 25–50 mg elemental zinc daily, divided into 1–3 doses.
* **Diarrhea (Adjunct):** 20 mg elemental zinc daily for 10–14 days.
* **Wilson Disease:** 50 mg elemental zinc administered 3 times daily (150 mg/day total).
* *Note: Long-term supplementation >40 mg/day should be medically supervised to avoid copper deficiency.*
## Pediatric Dosing
* **Diarrhea (WHO/UNICEF guideline for ages >6 months):** 20 mg elemental zinc daily for 10–14 days.
* **Diarrhea (Infants <6 months):** 10 mg elemental zinc daily for 10–14 days.
* **Deficiency Treatment:** Highly variable based on severity; typically 0.5–1 mg/kg/day of elemental zinc divided daily.
* *Consult local protocols for specific institutional nutritional support guidelines.*
## Dose Adjustments
* **Renal Impairment:** No standard dosage adjustment; monitor for accumulation in end-stage renal disease (ESRD) if chronic, though zinc is primarily excreted via the biliary/gastrointestinal route.
* **Hepatic Impairment:** Use caution; impaired biliary excretion may increase risk of toxicity.
## Contraindications
* Hypersensitivity to zinc or any formulation components.
## Adverse Effects
* **Common:** Nausea, vomiting, abdominal pain, diarrhea (often dose-dependent, associated with gastric irritation).
* **Serious (Chronic/Excessive use):** Copper deficiency, sideroblastic anemia, neutropenia, impaired immune function.
* **Inhaled/Intranasal:** Loss of smell (anosmia)—**avoid intranasal administration.**
## Key Drug Interactions
* **Quinolone/Tetracycline Antibiotics:** Zinc chelates these medications, significantly reducing absorption. Separate doses by at least 2 hours before or 4–6 hours after zinc.
* **Penicillamine:** Zinc decreases penicillamine absorption.
* **Copper:** High-dose zinc induces intestinal metallothionein, which traps copper and prevents its absorption, leading to secondary hypocupremia.
## Monitoring
* **Serum Zinc levels:** Often difficult to interpret due to redistribution during acute phase response (zinc levels drop during inflammation/infection).
* **Copper/Ceruloplasmin levels:** Monitor if long-term high-dose zinc therapy is required (>40 mg/day).
* **Hematologic parameters:** Monitor CBC to screen for anemia or neutropenia.
## Clinical Pearls
* **Bioavailability:** Zinc absorption is inhibited by phytates (grains, legumes) and calcium. Taking with food may reduce gastrointestinal side effects but also reduces absolute absorption.
* **Element vs. Salt:** Always verify the "elemental zinc" content on the label (e.g., 220 mg of Zinc Sulfate contains only ~50 mg of elemental zinc).
* **Trial Duration:** Short-term supplementation should be limited to the duration of the deficiency or diarrhea course.
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**Disclaimer:** This information is clinical support for healthcare professionals. Dosing protocols may vary by institution and patient-specific needs. Always verify current prescribing information, package inserts, and local organizational guidelines before administration.
