Considerations Regarding Zinc Supplements in Micronutrient Deficient Nursing Home Patients

To give or not give routine zinc supplements to patients being treated for pressure ulcers is a question fraught with controversy. The fear of causing a zinc toxicity, including anemia secondary to competition with copper and iron for absorption from the gut, is usually cited as the reason to withhold zinc supplements. There is no literature that reports changes in hematocrit and hemoglobin and serum zinc, ceruloplasmin and transferrin levels during zinc supplementation. Giving a micronutrient supplement with zinc was part of the standard treatment protocol for pressure wounds. The work reported here was a retrospective analysis and shows that even giving 100 mg elemental zinc daily for months, resulted in no change in any of these indices. To avoid giving zinc to patients who do not need it, a zinc taste test was done. The zinc taste is a functional test. A zinc solution is sprayed into the mouth of the subject. Zinc has a vile flavor to a healthy subject without a deficiency. A patient with a zinc deficiency cannot taste zinc. Zinc is the critical component of numerous protein mediated metabolic processes involved in structure, regulation and catalytic activity throughout the body. Further, matrix metalloproteinases (MMPs) are involved in every phase of healing and zinc is an essential component of MMP's. Supplementation in a micronutrient malnourished patient with a pressure wound is therefore very important. How to monitor for toxicity is presented. Once again, the zinc taste is useful in that a patient without a zinc deficiency will complain of the terrible taste and gastrointestinal upset. The patient will refuse to take another dose.