Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

acquired

1st line – zinc supplementation

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ACUTE
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acquired
1st line – 

zinc supplementation

For most people with acquired zinc deficiency, zinc can be adequately replenished with oral supplementation, with few adverse effects and at low cost. Unless the underlying cause can be adequately addressed (e.g., coeliac disease or dietary insufficiency), lifelong supplementation should be considered.

Various formulations of zinc supplements are available and may include zinc sulfate, zinc acetate, and zinc gluconate. It is important to note that the bioavailability of zinc formulations may differ significantly.

People with zinc deficiency should be monitored every 1 to 3 months to ensure that manifestations resolve and serum zinc levels normalise with supplementation. Once zinc status has normalised, patients with ongoing risk factors should be monitored every 12 months, or sooner if symptoms recur.

Although the recommended daily intake for zinc is relatively low, standard supplementation is approximately 20 to 40 mg/day orally for adults.[58]​ Higher doses of zinc (>50 mg/day) may be needed acutely in patients with severe deficiency. In acquired zinc deficiency, doses of 0.5 to 1 mg/kg/day of elemental zinc may be given orally for 3 to 4 months.[61]​ The specific dose will depend on the patient’s age, the formulation of zinc used, and the clinical indication. Consult your local micronutrient guidelines for more information.

Parenteral zinc is rarely necessary, except for patients with intestinal failure and/or on prolonged total parenteral nutrition.[62] In patients who require parenteral nutrition, the dose of elemental zinc depends on clinical factors. For those without excessive gastrointestinal (GI) losses, 3 to 5 mg/day of intravenous elemental zinc is recommended. Higher doses are recommended in patients with GI losses (up to 12 mg/day) or burns >20% of body surface area (up to 30 to 35 mg/day for a few weeks).[61]​​

Plus – treatment of underlying condition and symptomatic care

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ACUTE
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acquired
Plus – 

treatment of underlying condition and symptomatic care

Treatment recommended for ALL patients in selected patient group

For most people with acquired zinc deficiency, focus on amelioration of the predisposing condition is appropriate.

Conditions that place patients at risk for zinc deficiency include: malabsorption syndrome, chronic GI (coeliac disease or Crohn's disease) and liver disease, renal disease, sickle cell disease, and HIV infection.[1][2][3][4][6][7][8][9][10][11]​​​​ People undergoing chronic treatment with certain medication (e.g., hydrochlorothiazide, penicillamine, ethambutol, certain antibiotics), people with alcohol use disorder, vegetarians, vegans, and infants with nutrient-poor diets are more prone to zinc deficiency.[1][5]

Symptomatic management to alleviate GI symptoms (anorexia, glossitis, abdominal pain, diarrhoea) may be required.

Consider – copper supplementation

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ACUTE
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acquired
Consider – 

copper supplementation

Additional treatment recommended for SOME patients in selected patient group

Patients on long-term, high-dose zinc supplementation should be monitored for resulting copper deficiency. If copper deficiency is detected, low-dose copper supplementation is typically effective.

acrodermatitis enteropathica

1st line – lifelong zinc supplementation

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ACUTE
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acrodermatitis enteropathica
1st line – 

lifelong zinc supplementation

In acrodermatitis enteropathica, lifelong oral supplementation of elemental zinc (3 mg/kg/day) may be provided.[61]​ Long-term zinc supplementation may be guided by serial serum zinc measurement to individualise dosage.

Cessation of therapy leads to recurrence of signs and symptoms.

Because the skin manifestations of zinc deficiency are linked to enzyme impairment, topical treatments are generally ineffective.

Consider – copper supplementation

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ACUTE
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acrodermatitis enteropathica
Consider – 

copper supplementation

Additional treatment recommended for SOME patients in selected patient group

Zinc competes with copper absorption, so copper levels should be assessed regularly, and concurrent copper supplementation may be occasionally necessary.

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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