A case of zinc deficiency during long-term total parenteral nutrition

Abstract

A 54-year-old housewife received total parenteral nutrition (TPN) because of an intestinal fistula and total wound breakdown after an emergency operation for perforation of the ileum and diffuse peritonitis. The TPN regimen reversed the catabolism and resolved the abdominal wound and enterocutaneous fistula. Zinc and copper were not supplemented because there was no licensed parenteral trace element solution available. At week 17 of TPN, eczematoid dermatitis appeared on the face, nasolabial folds and chin, and the perineal area. These changes, coinciding with a serum zinc level of 20 micrograms/dl, were consistent with zinc deficiency. Zinc supplementation was commenced giving 6 mg of elemental zinc intravenously daily. The response to zinc therapy was very dramatic. Not only did the serum zinc level increase, but the skin changes returned to normal within 7 days. The patient gradually resumed her usual diet and TPN was discontinued after an approximate duration of 21 weeks. She was later discharged in good health.