Zinc deficiency is rarely severe and usually congenital. Milder zinc deficiency is usually acquired and is common in older people.
Manifestations of zinc deficiency may be subtle and can affect many organ systems. Delayed wound healing, impaired taste, loss of appetite, hair loss, fertility issues, and increased susceptibility to infection are common manifestations.
Plasma or serum zinc levels are useful in the evaluation of patients with suspected zinc deficiency. Milder forms of zinc deficiency may not be detected in plasma or serum tests, but supplementation may still be considered for patients with typical symptoms.
In most cases, standard oral zinc supplementation leads to increased zinc levels and amelioration of symptoms.
Zinc supplementation is generally safe, although acute toxicity with high doses may lead to adverse changes in immune, iron, copper, and cholesterol status, as well as to potential genitourinary problems.
Zinc deficiency is a lack of sufficient zinc to maintain optimal health, and may have genetic, nutritional, or metabolic etiologies. Zinc is a key micronutrient important in growth and development, immune function, taste, smell, wound healing, protein synthesis, and maintenance of skin and hair.
History and exam
Key diagnostic factors
- increased susceptibility to infection
- taste disorders
- delayed wound healing
- acrodermatitis enteropathica
- fertility issues/adverse pregnancy outcomes
Other diagnostic factors
- gastrointestinal symptoms
- short stature
- bone fracture
- impaired glucose tolerance
- weight loss
- intention tremor
- impaired concentration
- night blindness
- 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
- long-term vegetarian/vegan diets
- specialized weight-loss diets
- infants with nutrient-poor diets
- family history of zinc deficiency
- anorexia nervosa
1st investigations to order
- serum or plasma zinc levels
- serum iron level
- serum 25-OH vitamin D level
- serum folate
- serum vitamin B12
- cell zinc content
- analysis of zinc levels in hair
- genetic testing for acrodermatitis enteropathica
- Iron deficiency
- Japan's practical guidelines for zinc deficiency with a particular focus on taste disorders, inflammatory bowel disease, and liver cirrhosis
- 2020-2025 Dietary Guidelines for Americans
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