|Values are valid only on day of printing.|
Identifying the cause of abnormal serum zinc concentrations
Zinc is an essential element; it is a critical cofactor for carbonic anhydrase, alkaline phosphatase, RNA and DNA polymerases, alcohol dehydrogenase, and many other physiologically important proteins. Zinc also is a key element required for active wound healing.
Zinc depletion occurs either because it is not absorbed from the diet or it is lost after absorption. Dietary deficiency may be due to absence (parenteral nutrition) or because the zinc in the diet is bound to fiber and not available for absorption. Once absorbed, the most common route of loss is via exudates from open wounds such as third-degree burns or gastrointestinal loss as in colitis. Hepatic cirrhosis also causes excess loss of zinc by enhancing renal excretion. The peptidase, kinase, and phosphorylase enzymes are most sensitive to zinc depletion.
Zinc excess is not of major clinical concern. The popular American habit of taking mega-vitamins (containing huge doses of zinc) produces no direct toxicity problems. Much of this zinc passes through the gastrointestinal tract and is excreted in the feces. The excess fraction that is absorbed is excreted in the urine. The only known effect of excessive zinc ingestion relates to the fact that zinc interferes with copper absorption, which can lead to hypocupremia.
Reference values apply to all ages.
Fecal excretion of zinc is the dominant route of elimination. Renal excretion is a minor, secondary elimination pathway. Normal daily excretion of zinc in the urine is in the range of 300 to 600 mcg/L.
High urine zinc associated with low serum zinc may be caused by hepatic cirrhosis, neoplastic disease, or increased catabolism.
High urine zinc with normal or elevated serum zinc indicates a large dietary source, usually in the form of high-dose vitamins.
Low urine zinc with low serum zinc may be caused by dietary deficiency or loss through exudation common in burn patients and those with gastrointestinal losses.
High concentrations of barium are known to interfere with most metals tests. If barium-containing contrast media has been administered, a specimen should not be collected for 96 hours.
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