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[Enteropathic acrodermatitis in a patient with high-out-put ileostomy]
Sonia Junquera Bañares1, Eugenio Oria Mundín1, José Ignacio Botella-Carretero2
1Servicio de Endocrinología y Nutrición. Hospital de Navarra.. sojuba@hotmail.com.
Nutricion Hospitalaria
|February 18, 2014
Summary
Severe zinc deficiency can occur even with normal initial plasma levels, especially in patients with high-output ileostomies. Clinical improvement from zinc supplementation often precedes normalization of plasma zinc levels.
Area of Science:
- Clinical Medicine
- Nutritional Science
- Gastroenterology
Background:
- Zinc deficiency is common in certain conditions but rarely presents with distinct clinical signs.
- A patient presented with hyponatremic dehydration and pre-renal failure due to high-output ileostomy and oral intolerance.
Observation:
- Despite normalized ileostomy output and initially normal zinc plasma levels, the patient developed severe zinc deficiency after receiving TPN with 13 mg/day zinc.
- Enteropathic acrodermatitis, a sign of zinc deficit, resolved within a week of increasing zinc supplementation to 26.5 mg/day.
Findings:
- Plasma zinc levels are not a reliable indicator of total body zinc stores and can lag behind actual zinc status.
- Clinical resolution of zinc deficiency symptoms occurred rapidly, while plasma zinc levels took a month to normalize.
Implications:
- This case highlights the inadequacy of plasma zinc levels as a sole diagnostic marker for zinc status, especially in patients with gastrointestinal issues.
- Aggressive zinc repletion may be necessary for clinical recovery, independent of rapid plasma level normalization.
- Clinicians should consider zinc status in patients with unexplained symptoms despite seemingly normal lab values.
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