Last reviewed: 25 Oct 2020
Last updated: 21 Mar 2018



History and exam

Key diagnostic factors

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

Other diagnostic factors

  • fatigue
  • gastrointestinal 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 gastrointestinal (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
More 1st investigations to order

Emerging tests

  • cell zinc content
  • analysis of zinc levels in hair
  • genetic testing for acrodermatitis enteropathica
More emerging tests

Treatment algorithm


Fellow in Gastroenterology

Beth Israel Deaconess Medical Center




PS declares that he has no competing interests.

Instructor in Medicine

Division of Gastroenterology

Beth Israel Deaconess Medical Center




JN declares that she has no competing interests.

Dr Prashant Singh and Dr Judy Nee would like to gratefully acknowledge Dr Daniel Leffler, a previous contributor to this monograph.


DL declares that he has no competing interests.

Peer reviewersVIEW 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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