Last reviewed: November 2017
Last updated: June  2016



History and exam

Key diagnostic factors

  • presence of risk factors
  • increased susceptibility to infection
  • delayed wound healing
  • stomatitis
  • acrodermatitis enteropathica
  • fertility issues/adverse pregnancy outcomes

Other diagnostic factors

  • fatigue
  • GI symptoms
  • short stature
  • bone fracture
  • impaired glucose tolerance
  • dermatitis
  • weight loss
  • alopecia
  • paronychia
  • fever
  • intention tremor
  • depression
  • impaired concentration
  • nystagmus
  • dysarthria
  • night blindness
  • hypogeusia
  • anosmia
  • blepharitis
  • dementia

Risk factors

  • living in a developing region
  • age >65 years
  • chronic GI and liver disease
  • renal disease
  • sickle cell disease
  • diabetes mellitus
  • chronic treatment with hydrochlorothiazide, penicillamine, ethambutol, certain antibiotics
  • HIV infection
  • alcoholism
  • long-term vegetarian/vegan diets
  • specialised weight-loss diets
  • infants with nutrient-poor diets
  • FHx of zinc deficiency
  • anorexia nervosa

Diagnostic investigations

1st investigations to order

  • serum or plasma zinc levels
  • serum iron level
  • serum 25-OH vitamin D level
  • serum folate
  • serum vitamin B12
Full details

Emerging tests

  • cell zinc content
  • analysis of zinc levels in hair
  • genetic testing for acrodermatitis enteropathica
Full details

Treatment algorithm


Authors VIEW ALL

Daniel Leffler

Assistant Professor of Medicine

Beth Israel Deaconess Medical Center

Harvard Medical School

Director of Clinical Research

The Celiac Center




DL declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor for low molecular weight immune regulators

Institute of Immunology

University Hospital

RWTH Aachen University




HH has been reimbursed by Kohler Pharma, the manufacturer of UNIZINK, for attending a symposium and has received a fee for speaking at that symposium. HH is an author of a number of references cited in this monograph.

Professor of Medicine

Baylor University Medical Center




AF declares that he has no competing interests.

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