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Zinc deficiency

Last reviewed: 10 Nov 2023
Last updated: 11 Jan 2022



History and exam

Key diagnostic factors

  • increased susceptibility to infection
  • taste disorders
  • stomatitis
  • delayed wound healing
  • acrodermatitis enteropathica
  • fertility issues/adverse pregnancy outcomes
More key diagnostic factors

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
Other diagnostic factors

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
  • specialized weight-loss diets
  • infants with nutrient-poor diets
  • family history of zinc deficiency
  • anorexia nervosa
More risk factors

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

Treatment algorithm



acrodermatitis enteropathica



Prashant Singh, MD

Assistant Professor of Medicine

Division of Gastroenterology and Hepatology

University of Michigan

Ann Arbor




PS declares that he has no competing interests.

Judy Nee, MD

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 topic.


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




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 topic.

Andrew Fenves, MD

Professor of Medicine

Baylor University Medical Center




AF declares that he has no competing interests.

  • Zinc deficiency images
  • Differentials

    • Hypothyroidism
    • Depression
    • Iron deficiency
    More Differentials
  • Guidelines

    • 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
    More Guidelines
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