Zinc
The newly established dietary reference intake (DRI) for daily zinc intake in healthy adults is 8 mg for females and 11 mg for males. An upper limit (UL) has also been established at 40 mg/day as the highest level likely to pose no risk to the general population.
Zinc losses related to chronic diarrhea or malabsorptive diseases often require zinc supplementation to prevent deficiency. In adults, diarrhea or ileostomy effluent contains 17 mg/kg. Proximal small intestinal fluid effluent via fistula or stoma contains 12 mg/l.Oral multivitamin/multimineral supplements containing 10–20 mg elemental zinc on average may suffice or zinc sulfate may be required. Adults on parenteral nutrition with outputs <300 g/day typically receive 3–5 mg/day zinc and those with outputs>300 g/day, 10–25 mg respectively.
Little is known about the amount of additional zinc needed to support pharmacologic functions, i.e., wound healing. Caution is prudent, as zinc interacts with copper and a normal copper status is also necessary for optimal wound healing. Data shows 50 mg of elemental zinc given for 10 weeks can induce copper deficiency. Clearly, the dose of supplemental zinc given for wound healing and the time period over which supplementation occurs must be carefully considered.
A general guideline commonly used in clinical practice when supplementing wound patients is up to 50 mg of elemental zinc (220 mg zinc sulfate) three times a day for approximately two weeks. This amount of zinc is in addition to a typical oral diet but part of the daily total ingested for a tube-fed patient. Standard tube feedings provide 10–19 mg zinc/1000 calories and those for healing support provide 24–30 mg zinc/1000 calories.
As always, there is no substitute for good clinical judgment exercised according to an individual assessment of the patient’s wounds, nutritional status and conditions predisposing to zinc deficiency. An ongoing assessment by the wound care team for zinc supplementation is a must.
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