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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 in various salt forms (e.g., gluconate, sulfate, acetate), which differ in elemental zinc content. Always clarify the ordered dose (elemental vs. salt form).
## Primary Indications
Dietary supplementation for zinc deficiency, adjunct in the treatment of Wilson’s disease (acetate form), and supportive care for pediatric diarrhea (WHO/UNICEF global recommendations).
## Adult Dosing
* **Deficiency Treatment:** 25–50 mg elemental zinc daily.
* **Wilson’s Disease:** 50 mg elemental zinc 3 times daily.
* **Common Cold (OTC):** Lozenge doses vary significantly; clinical benefit is most noted if initiated within 24 hours of symptom onset (typically 50–75 mg elemental zinc/day in divided doses).
## Pediatric Dosing
* **Diarrhea (Acute):** 20 mg elemental zinc daily for 10–14 days (infants >6 months; 10 mg/day for <6 months).
* **Deficiency:** 0.5–1 mg/kg/day elemental zinc (max 20–40 mg/day).
* *Note: Dosing depends heavily on local guidelines and severity of deficiency.*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines; use caution in severe impairment. Generally, zinc is excreted primarily via the GI tract, but adjust monitoring based on clinical status.
## Contraindications
Hypersensitivity to zinc or any formulation components.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, epigastric pain, metallic taste.
* **Serious (Chronic high-dose):** Copper deficiency (leading to anemia and neutropenia), impaired immune function, and reduced HDL cholesterol.
## Key Drug Interactions
* **Antibiotics:** Zinc chelates with **Fluoroquinolones** and **Tetracyclines**, significantly reducing their absorption. Space doses by at least 2–4 hours (zinc after antibiotic).
* **Penicillamine:** Zinc reduces absorption of penicillamine; space doses by 2 hours.
* **Iron:** High doses of iron may interfere with zinc absorption.
## Monitoring
* **Long-term use:** Serum zinc levels, copper levels (to screen for secondary deficiency), and lipid panel.
* **Acute use:** Monitor for resolution of deficiency symptoms or gastrointestinal tolerance.
## Clinical Pearls
* **Elemental Zinc Content:** Zinc sulfate contains ~23% elemental zinc; Zinc gluconate contains ~14%; Zinc acetate contains ~30%.
* **GI Tolerance:** Administer with food to reduce gastric irritation, although high-calcium or high-phytate meals (phytic acid in grains) can significantly reduce zinc absorption.
* **Toxicity:** Acute ingestion of massive amounts (>2 g) can cause severe erosive gastritis, hematemesis, and multi-organ failure.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify dosing, contraindications, and drug interactions against current institutional protocols, primary literature, and the manufacturer’s official prescribing information (package insert) before prescribing or administering medication.
