Role of Zinc in Diarrhea and it's evidence

1. Role of Zinc in
Diarrhea
PREPARED BY:
ANISH DHAKAL
(ARYAN)
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2. Contents
Zinc
◦ Absorption & Metabolism
◦ Role in Diarrhea
◦ Research findings
◦ Dosage form
◦ Research Studies
◦ Interactions
◦ Side effects
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3. Zinc
Modulates host resistance to infectious agents and reduces the risk,
severity, and duration of diarrheal diseases
Intracellular hormone contributing to regulation of cellular growth
Roles on nucleic acid metabolism and protein synthesis
Zinc dependant:
• Thymidine kinase
• DNA polymerase
• RNA polymerase
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4. Absorption & Metabolism
Poorly absorbed from GIT
Endogenous zinc is reabsorbed in the ileum and
colon, creating enterohepatic circulation.
Small Intestine (facilitated diffusion) Portal
System (albumin and transferrin)  Liver 
Systemic Circulation (albumin)
Excreted in feces (90%), urine
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5. Role in Diarrhea
Inhibits cAMP-induced, chloride-dependent fluid
secretion by inhibiting basolateral potassium (K)
channels
Improves the absorption of water and electrolytes
Improves regeneration of the intestinal epithelium
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6. Contd…
Enhances the immune response, allowing for a
better clearance of the pathogens
Zinc therapy in acute shigellosis showed enhanced
antigen-specific antibody responses
Zinc supplementation in addition to ORT can
reduce inappropriate antimicrobials use that leads to
resistant pathogens
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7. Role in maintaining barrier
Zinc is also needed for cell replication and is thus essential
for the regeneration of the intestinal mucosa, the healing of
wounds and the turnover of epithelial cells necessary to
maintain healthy skin.
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8. Contd…
Decreases frequency, incidence and prevalence of both diarrhea and
pneumonia
Role in metabolism- Protein synthesis, Nucleic acid, carbohydrate
metabolism
Epithelial tissue integrity, cell repair and division
Vitamin A and E uptake, transport and utilization
Immune function & synthesis of reproductive hormone
As an anti rhino viral & anti malassezial
As an anti-oxidant & anti inflammatory
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9. Zinc supplementation in the
treatment and prevention of
bloody diarrhea
Zinc therapy was associated with enhanced antigen-specific antibody
responses.
◦The bactericidal antibody titers against Shigella increased the proportions
of B cells and plasma cells, as also higher lymphocyte proliferation
responses in the peripheral circulation, during the early convalescent phase
of shigellosis.
For all these reasons, zinc supplementation should be given as an adjunct to
antimicrobial treatment in bloody diarrhea.
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10. Global Zinc Deficiency Risk
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Bhandari et.al. (Nepal): 12% (average= 12%) lower
frequency & 22% (average=15.5%) lower probability
of diarrhea

17. Dosage form
Zinc sulfate, acetate, and gluconate
Zinc sulfate is low-cost, efficacious, safe, and therefore, optimal for the
national program
Zinc sulfate tablets dispersed in
◦ breast milk
◦ ORS
◦ water on a small spoon
Older children may chew the tablets or swallow them with water
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18. Contd…
Orally, as an adjunct to ORT in acute diarrhea
Under six months
◦ 10 mg daily for 10 – 14 days
Six months - Five years
◦ 20 mg daily for 10 - 14 days
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19. Interactions
Reduce absorption by:
◦ Phytate, which is present in staple foods like cereals, corn and rice
◦ Dairy products and brown bread
◦ Coffee
◦ Iron supplements: Zn supplements are administered two hours before iron
supplements
◦ Penicillamine and other chelators
◦ Calcium salts
◦ Oral tetracyclines: Zn supplements are administered two hours before
tetracyclines
Increased excretion by:
◦ Thiazides
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20. Amino acids, such as histidine and methionine, and other low-
molecular-weight ions, such as EDTA and organic acids (e.g., citrate),
enhance zinc absorption.
Zn inhibits copper absorption from the intestine.
Thiazide diuretics increase urinary excretion of Zn.
Zinc reduces absorption of Ciprofloxacin, Levofloxacin, and Ofloxacin.
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21. Side effects
No reports of severe adverse reactions from any form of zinc
supplementation used in the treatment of diarrhea.
>40 mg per day
◦ Interfere with the metabolism and absorption of other essential minerals
specially iron, magnesium, and copper
◦ reduce the body's immune function
◦ reduce the HDL level
Stomach upset, heartburn and nausea
Rarely fever, sore throat, mouth sores, weakness and fatigue
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22. References
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113371/
Ghai O.P. et al, Ghai Essential Pediatrics, 7th
edition
Nelson Textbook of Pediatrics, 20th
edition
www.who.int/elena/titles/bbc/zinc_diarrhoea/en/
www.zinc.org/case_studies_documents/zinc_advocacy_USAID.pdf
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