Trace Element Dosing

Chromium

Copper

Fluoride

Iodine

Iron

Manganese Molybdenum Selenium Zinc

0.01 to 0.2 mg 0.4 to 3 mg 0.1 to 4 mg 0.04 to 0.2 mg 6 to 15 mg 0.3 to 0.5 mg 0.015 to 0.25 mg 0.01 to 0.075 mg 5 to 16 mg

There are approximately 2 to 3 g zinc stores, of which about one fifth is in bone and one half is in the liver. Much of the remaining zinc is in the skeletal muscle. Serum binding is about 55% albumin and 40% to an a-macroglobulin (a zinc metalloprotein). Zinc is lost in fistula output and diarrhea (12 and 17 mg/l, respectively).

Treatment of zinc deficiency may require up to tenfold increments of the parenteral zinc dosages. If infused steadily over the course of 24 h, dosages of 50 to 100 mg/d elemental zinc can be tolerated. Zinc deficiency signs and symptoms include alopecia, diarrhea, glucose intolerance, hypospermia, impaired chemotaxis, night blindness, depression, apathy, and delayed wound healing.

Zinc, like chromium, also works in concert with insulin. About one fourth of oral zinc is absorbed daily in the duodenum and proximal jejunum. Other divalent trace elements, such as copper and iron, may suppress zinc absorption. Vitamin D may increase zinc bioavailability. Human peripheral blood lymphocytes have the capacity to produce metallothioneins (MTs) as a protective response to heavy metal exposure. Zinc, like iron, is redistributed to the liver under the direction of leukocytic endogenous mediator (LEM, IL-1) during infection. Sweat (up to 1 mg zinc per liter) and skin losses become important with dermatologic patients or those with burns, because muscle, bone, and liver account for greater than 2 g of total body stores. A marked decrease in skin zinc concentration may contribute to skin lesions and to impaired wound healing in skin.

Adverse reactions to zinc include nausea, vomiting, anorexia, and hyperamylasemia. The reciprocal relationship of zinc and molybdenum to copper must also be respected, particularly because copper can be depressed with zinc loading over long periods of time. The sideroblastic anemia that results is manifested by an iron-like microcytic, hypochromic anemia, and neutropenia. Other zinc deficiency signs and symptoms include skin lesions, dermatological anergy, growth retardation, impaired taste, immu-nological impairment, glucose intolerance (similar to chromium deficiency), alopecia, hypogonadism, hypospermia, mental depression, and diarrhea. Serum testosterone concentrations, seminal volume, and total seminal zinc loss per ejaculate are sensitive to short-term zinc depletion in young men. Diseases (sickle cell anemia, malignancies, diabetes, inflammatory or infectious conditions) and medications (e.g., estrogens, caffeine, theophylline, and corticosteroids) can result in greater zinc losses.

Zinc protects against ultraviolet (UV) radiation, enhances wound healing, contributes to immune and neuropsychiatric functions, and decreases the relative risk of cancer and cardiovascular disease. All body tissues contain zinc; in skin, it is five to six times more concentrated in the epidermis than the dermis. Zinc is required for the normal growth, development, and function of mammals. It is an essential element of hundreds of metalloenzymes, including superoxide dismutase. Zinc is also important for the proper functioning of the immune system and for glandular, reproductive, and cell health. Abundant evidence demonstrates the antioxidant role of zinc. Topical zinc, in the form of divalent zinc ions, has been reported to provide antioxidant photoprotection for skin. Two antioxidant mechanisms have been proposed for zinc: zinc ions may replace redox active molecules, such as iron and copper, at critical sites in cell membranes and proteins; alternatively, zinc ions may induce the synthesis of MT, sulfhydryl-rich proteins that protect against free radicals. Topical zinc ions may provide an important and helpful antioxidant defense for skin.93

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