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# Zinc (Elemental)
## Overview
Zinc is an essential trace element involved in DNA synthesis, protein metabolism, and immune function. It acts as a cofactor for over 200 enzymes. It is available as various salts (e.g., zinc gluconate, sulfate, acetate), each providing different percentages of elemental zinc.
## Primary Indications
* Treatment/prevention of zinc deficiency.
* Parenteral nutrition (trace element supplementation).
* Adjunct therapy for Wilson’s disease (zinc acetate).
* Supportive care for pediatric acute diarrhea (WHO/UNICEF).
## Adult Dosing
* **Deficiency Treatment (Elemental Zinc):** 25–50 mg elemental zinc daily.
* **Wilson’s Disease (Zinc Acetate):** 50 mg elemental zinc 3 times daily.
* **Dietary Supplementation:** Typically 10–20 mg/day; avoid chronic intake >40 mg/day due to toxicity risk.
## Pediatric Dosing
* **Acute Diarrhea (WHO Recommendation):** 6 months to 5 years; 20 mg elemental zinc daily for 10–14 days. Infants <6 months; 10 mg daily for 10–14 days.
* **Parenteral Nutrition (Trace Element Supplement):**
* Preterm infants (<3 kg): 400 mcg/kg/day.
* Term infants to 5 years: 250 mcg/kg/day.
* Children >5 years: 2.5–5 mg/day.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment; however, zinc is renally cleared; monitor for accumulation in patients with severe renal failure.
* **Hepatic Impairment:** No standard adjustment.
## Contraindications
* Hypersensitivity to zinc or any formulation component.
* Avoid high doses in patients with copper deficiency (copper should be monitored).
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, abdominal cramps, diarrhea (often dose-dependent, minimize by taking with food).
* **Chronic Toxicity:** Copper deficiency leading to sideroblastic anemia and neutropenia; impaired immune function.
* **Intranasal (Not recommended):** Anosmia (loss of smell).
## Key Drug Interactions
* **Antibiotics:** Zinc chelates with **tetracyclines** and **fluoroquinolones**, significantly reducing their absorption. Separate dosing by at least 2–4 hours.
* **Penicillamine:** Zinc decreases penicillamine absorption/efficacy.
* **Iron:** High-dose iron supplementation may inhibit zinc absorption.
## Monitoring
* **Chronic Use:** Serum zinc levels (though often unreliable due to wide distribution).
* **Long-term High Dose:** Serum copper levels and CBC (to monitor for anemia/neutropenia associated with secondary copper deficiency).
## Clinical Pearls
* **Elemental Conversion:** Read labels carefully. Zinc sulfate heptahydrate is ~23% elemental zinc, while zinc gluconate is ~14%. Dosing must be based on elemental weight.
* **Bioavailability:** Food, specifically phytates (found in whole grains/legumes), can reduce zinc absorption.
* **Wilson’s Disease:** Zinc is for maintenance therapy, not initial treatment of symptomatic Wilson’s disease.
* *Note: Specific institutional protocols or nutrition guidelines may apply for patients receiving TPN or specialized metabolic management.*
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**Educational Disclaimer:** This information is for educational purposes and does not substitute for clinical judgment. Always verify current prescribing information, institutional guidelines, and drug compatibility before administration.
