Last reviewed: 18 Aug 2021
Last updated: 21 Mar 2018

Summary

Definition

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

Emerging tests

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

Treatment algorithm

Contributors

Authors

Prashant Singh, MD

Fellow in Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

PS declares that he has no competing interests.

Judy Nee, MD

Instructor in Medicine

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

JN declares that she has no competing interests.

Acknowledgements

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

Disclosures

DL declares that he has no competing interests.

Peer reviewers

Hajo Haase, PhD

Assistant Professor for low molecular weight immune regulators

Institute of Immunology

University Hospital

RWTH Aachen University

Aachen

Germany

Disclosures

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.

Andrew Fenves, MD

Professor of Medicine

Baylor University Medical Center

Dallas

TX

Disclosures

AF declares that he has no competing interests.

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