The Role of Zinc in Total Parenteral Nutrition

Principi, Nicola; Giunta, Anna; Gervasoni, Annalisa

doi:10.1111/j.1651-2227.1979.tb04973.x

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…During 13 months of TPN, height and weight could be maintained near the third percentile but there were several untoward side effects. The most obvious of these was secondary zinc deficiency, which has been reported by several authors [1,19,22,23,25]. Hypozincaemia led to the symptoms ofacrodermatitis enteropathica which were recieved by parenteral zinc therapy.…”

Section: Discussionmentioning

confidence: 92%

“…Total parenteral nutrition (TPN), has improved therapeutic conditions and prognosis of these children on the other hand, but on the other, TPN gives rise to many secondary problems. Thus, acrodermatitis enteropathica [ 15,17,18,26] has been reported, if sufficient zinc is not supplied during TPN [1,11,12,19,22,23,25]. Deficiencies of other food substances, e.g.…”

Section: Introductionmentioning

confidence: 96%

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Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Stern¹,

Grüttner²,

Krumbach³

1980

Eur J Pediatr

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Protracted diarrhoea in early infancy gives rise to many diagnostic and therapeutic problems. Jejunal biopsy often reveals villous atrophy of varying degrees. Severe reduction of small intestinal absorptive area causes secondary monosaccharide malabsorption, as well as secondary disaccharide deficiency, consequences which are relevant in any attempts at oral feeding. Morphologic, metabolic, endocrinological and microbiological studies have to be undertaken in order to establish a definitive diagnosis in protracted diarrhoea, but these studies often fail to reveal the aetiology of the disease. Immunologic abnormalities like phagocyte dysfunction, thymic atrophy and hypoplasia of B-cell regions in lymph nodes might be secondary events, but some types of immunodeficiency are of primary importance in the development of protracted diarrhoea. Total parenteral nutrition in many cases has to be instituted, with all its implications and hazards: septicaemia is the most dangerous of these. Zinc deficiency and acrodermatitis enteropathica may occur during total parenteral nutrition, and zinc deficiency secondarily contributes to the symptoms of diarrhoea. Parenteral administration of zinc is able to overcome these effects.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 96%

Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Stern¹,

Grüttner²,

Krumbach³

1980

Eur J Pediatr

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“…Our study reveals no differences between groups in SOD levels and no increase in infants with BPD, although increased enzyme levels are seen in animals exposed to hyperoxia for as little as 18-24 h.4,5 Clinical evidence of zinc deficiency has been seen in infants with zinc levels as high as 56 Agldl, although most levels have been less than 40 Agldl. [21][22][23][24][25] In adults with gastrointestinal disease requiring TPN, zinc deficiency developed in 50% of patients with plasma levels less than 50 Jlg/d1.26 Six of 21 infants in groups II and III had levels less than 55 pg/dl at sample B, and 8 of 17 were below 55 ~g/dl by sample D. Only one level of all of the samples for babies in group I declined to this degree.…”

Section: Discussionmentioning

confidence: 98%

Relationship of Antioxidant Enzymes to Trace Metals in Premature Infants

Huston¹,

Shearer²,

B³

et al. 1987

Journal of Parenteral and Enteral Nutrition

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Serum levels of the trace metals copper, zinc, and selenium were measured in premature infants. White blood cell glutathione peroxidase and superoxide dismutase levels were measured in conjunction with the trace metals. Three groups of infants were evaluated: group I was relatively healthy, group II were infants with stage 2 bronchopulmonary dysplasia (BPD) or less, group III were infants with stage 3 BPD or worse. Zinc and selenium levels declined in all groups during conventional parenteral nutrition (TPN) regimens, while copper remained stable. Copper did decline in groups I and II coincident with an acceleration in growth rate. An expected rise in antioxidant enzyme levels in infants with pulmonary oxygen toxicity was not seen. This study suggests that supplemental selenium as well as an increased zinc intake over current recommendations for premature infants receiving TPN may be indicated.

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“…So far, the reported cases of acute zinc deficiency in the course of TPA have been attributed to a lack of this trace element in the various intravenous solutions used in the different TPA regimens, with the exception of the small amounts of it that could result from contamination [42], or to insufficient supplemental doses of zinc [33]. The recommended daily intake of zinc ranges between 10 and 15 mg [40]; between 10% [51] and 33% [44] of this is absorbed.…”

Section: Discussionmentioning

confidence: 99%

Acquired Zinc Deficiency Syndrome during Total Parenteral Alimentation

et al. 1981

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An acute zinc deficiency state developed in 6 patients on total parenteral alimentation, which allegedly included zinc 37 μmol/l. The actual concentration of this trace element when measured by us, was 3 μmol/l. The clinical picture consisted of an acrodermatitis enteropathica-like syndrome, with subsequent development of distinctive nail lesions, which consisted of white transverse bands in all finger- and toenails. Histopathological examination of several of these cutaneous lesions revealed distinctive changes, which we consider rather specific of zinc deficiency states. They consisted in parakeratosis, cleavage and detachment of the superficial layers of the epidermis, mainly intracellular and also extracellular edema of the epidermal cells, development of microvesicles at different epidermal levels, and severe vacuolar alteration of the dermoepidermal junction. These changes also affected the outer root sheath of the hair follicles.

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The Role of Zinc in Total Parenteral Nutrition

Cited by 9 publications

References 11 publications

Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Relationship of Antioxidant Enzymes to Trace Metals in Premature Infants

Acquired Zinc Deficiency Syndrome during Total Parenteral Alimentation

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