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# Zinc ## Overview Zinc is an essential trace element required for protein synthesis, wound healing, immune function, and DNA synthesis. It exists as a cofactor for over 300 enzymes. Elemental zinc content varies significantly by salt form (e.g., zinc gluconate ~14%, zinc sulfate ~23%, zinc acetate ~30%). ## Primary Indications - Prevention and treatment of zinc deficiency (e.g., malabsorption, prolonged parenteral nutrition). - Wilson disease (zinc acetate). - Adjunctive therapy for acute diarrhea (WHO/UNICEF guidelines). ## Adult Dosing - **Zinc Deficiency:** 25–50 mg elemental zinc daily. - **Wilson Disease:** 50 mg elemental zinc TID. - **Acute Diarrhea:** 20 mg elemental zinc daily for 10–14 days. - **Maximum:** Tolerable Upper Intake Level (UL) is 40 mg/day for chronic use; higher doses for specific pathologies should be under specialist supervision. ## Pediatric Dosing - **Zinc Deficiency:** 0.5–1.0 mg/kg/day elemental zinc. - **Acute Diarrhea (WHO/UNICEF):** - Infants <6 months: 10 mg elemental zinc daily for 10–14 days. - Children ≥6 months: 20 mg elemental zinc daily for 10–14 days. - **Note:** Safety and efficacy for other pediatric indications depend heavily on local institutional protocols. ## Dose Adjustments - **Renal Impairment:** No formal dosage adjustment guidelines; use with caution as zinc is primarily excreted via the biliary tract, but monitoring for accumulation is prudent in severe renal failure. ## Contraindications - Hypersensitivity to zinc products. ## Adverse Effects - **Gastrointestinal:** Nausea, vomiting, epigastric pain, metallic taste (most common with oral supplementation). - **Long-term/High-dose:** Copper deficiency (manifesting as anemia or neutropenia), sideroblastic anemia, and impaired immune function due to copper-zinc antagonism. ## Key Drug Interactions - **Fluoroquinolones/Tetracyclines:** Zinc forms insoluble chelates; separate administration by at least 2–4 hours. - **Copper:** Concurrent supplementation may be required to prevent induced copper deficiency. - **Penicillamine:** Zinc decreases absorption of penicillamine; space doses by 2 hours. ## Monitoring - Serum zinc levels (reference ranges vary by laboratory; interpret with caution as serum zinc is a poor marker of total body stores). - Monitor serum copper and ceruloplasmin during high-dose or long-term therapy to identify induced copper deficiency. - Monitor for signs of anemia or neutropenia. ## Clinical Pearls - **Bioavailability:** Zinc gluconate and zinc sulfate are common, but GI tolerance varies. Taking zinc with food can reduce nausea but may decrease absorption. - **Wilson Disease:** Zinc works by inducing intestinal metallothionein, which blocks copper absorption; it is generally used for maintenance therapy or in intolerant patients. - **Intranasal zinc:** Avoid use (e.g., cold remedies) due to reports of permanent anosmia (loss of smell). - **Toxicology:** Acute ingestion of extremely high doses (e.g., pennies, industrial exposure) can cause corrosive GI damage and systemic toxicity. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. Verify all dosages, contraindications, and drug interactions against institutional protocols and the most current prescribing information (e.g., package inserts or clinical databases like Lexicomp or Micromedex) before prescribing.*