Clinical zinc deficiency during zinc-supplemented parenteral nutrition

Acrodermatitis Enteropathica: Case Report and Review of the Literature

“…However, this postulate has never been substantiated. Intestinal malabsorption syndromes (10)(11)(12) Extensive burns (9) Crohn disease (10)(11)(12) Sickle cell anemia (9) Sprue (9) Systemic malignancies (9-12) Pancreatic insufficiency (9) Renal tubule dysfunction (9) Drugs (9) Defect of mammary zinc secretion (17,(20)(21)(22)(23)(24)(25)(26)(27) Blind loop syndromes (9) Diets high in phytates and calcium (7,17,28) Total parenteral nutrition (13)(14)(15)(16)(17)(18)(19) Prematurity (29,30) The use of Diodoquin was abandoned due to its serious adverse effects, optical atrophy being the main one (31). Since the Moynahan and Barnes (1) study in 1973, oral administration of a zinc preparation has been the treatment of choice.…”

Role of trace elements in parenteral nutrition support of the surgical neonate

“…Zinc losses in intestinal fluid were first quantified in a cohort of adult surgical patients [10]. Quantifications of Zn losses in intestinal and gastric drainage in infants also revealed significant net losses of this trace mineral relative to parenteral intake, with increased enterostomy drainage in preterm infants correlating with lower plasma Zn and resulting in clinical signs of Zn deficiency [11][12][13]. Zinc losses progressively increase with more distal GI fluid losses/secretions, likely caused by increased Zn secretion in portions of the GI tract more distal to the normal site of Zn absorption.…”

“…Protein accretion associated with positive energy and nitrogen balance increases the infant requirement of Zn for tissue synthesis; for the premature surgical neonate entering this phase with already decreased Zn stores, the increased demand for Zn may drive this trace element from skin stores toward other tissue to accommodate accelerated protein synthesis and DNA replication [9]. Faster growth in preterm infants is associated with lower serum Zn, and several case reports describing skin manifestations of Zn deficiencies in surgical infants reported a period of rapid weight gain immediately preceding the diagnosis [11,14,23]. In the animal model, parenteral energy provision is negatively correlated with serum Zn levels in laparotomized rats during the postoperative period [24].…”

Trace Metal Abnormalities in Adults During Hyperalimentation

“…Many of these patients were also very catabolic and some had enterocutaneous fistulae. It has been well documented by several groups that both fistulae and catabolic states can markedly increase Zn losses and increase Zn requirements.lO, 20, 2s, 32 We conclude that: (1) most hyperalimentation solutions contain inadequate amounts of Zn; (2) many patients receiving hyperalimentation are probably Zn-deficient before ever starting hyperalimentation; (3) Zn deficiency may complicate even short-term hyperalimentation ; (4) plasma is not an adequate source of Zn during hyperalimentation; and (5) hyperalimentation should be accompanied by Zn supplementation and, if IV Zn preparations are not available, oral Zn is usually effective in replacing Zn losses.…”

“…Zn deficiency may present as severe diarrhea, and we have observed patients whose diarrhea persisted while taking nothing by mouth.&dquo; Acrodermatitis enteropathica also has diarrhea as one of its principal features.3' Some patients who have diarrhea with Zn deficiency have very high Zn concentrations in their stools, and this accounts for cyclic worsening of both Zn status and diarrhea in these patients. 32 The mechanism for this diarrhea is as yet unknown. Some investigators have postulated abnormalities in small bowel Paneth cells (known to contain high concentrations of Zn), but we have been unable to document alterations in Paneth cells in our rat model for Zn deficiency.'…”