Zinc in Diarrhoea

Rationale

Zinc is an essential micronutrient that plays a critical role in the management of diarrheal diseases.
Zinc deficiency is associated with an increased risk of morbidity and mortality from diarrhea and pneumonia.
Children with diarrhea, particularly those with persistent diarrhea and malnutrition, often have markedly depressed serum zinc levels due to intestinal losses and poor intake.
Mechanism of Action in Diarrhea:
- Mucosal Healing: Zinc improves epithelial repair and regeneration of the intestinal mucosa.
- Enzymatic Function: It improves the function of brush border enzymes.
- Immunity: It boosts T-cell immunity and restores mucosal barrier integrity.
- Fluid Regulation: It aids in the regulation of water and electrolytes in the intestines.

Reduction in Duration and Severity: Zinc supplementation significantly reduces the duration and severity of the current diarrheal episode.
Reduction in Stool Output: It decreases the volume of stool output.
Preventive Effect (The "Prophylactic" Effect): Giving zinc for the full course helps prevent subsequent episodes of diarrhea for the next 2–3 months.
General Health: It increases the child's appetite and makes the child stronger during recovery.

Target Group: All children with acute diarrhea, persistent diarrhea, or dysentery.
Duration: Zinc must be given for a total of 14 days, even if the diarrhea stops earlier, to ensure the preventive benefit.
Dosage Stratification:
- Infants 2 months to < 6 months: 10 mg elemental zinc per day (½ tablet of 20 mg).
- Children 6 months to 5 years: 20 mg elemental zinc per day (1 tablet of 20 mg).
Administration Technique:
- For infants, the tablet (or half tablet) can be dissolved in a spoon with expressed breast milk or water.
- The tablet dissolves easily; there is no need to crush it.
- If the child vomits within 10 minutes of administration, the dose should be repeated.
- If the child spits it out, the caregiver should try to gather the solution and feed it again.

Zinc is a core component of Plan A (Home care for no dehydration) and Plan B (Treatment of some dehydration).
It is given in addition to Oral Rehydration Solution (ORS) and continued feeding.

In children with diarrhea lasting 14 days or more, zinc supplementation is mandatory to aid mucosal recovery.
It is given alongside dietary modifications (low lactose/lactose-free diets) and multivitamins.

Children with visible blood in stools (dysentery) should receive zinc supplements for 14 days in addition to appropriate antibiotics (e.g., Ciprofloxacin or Ceftriaxone).

Children with SAM have profound zinc deficiency.
Dosage in SAM: Guidelines recommend 2 mg/kg/day.
Alternatively, IMNCI operational guidelines for SAM suggest the standard 10 mg/20 mg regimen for 14 days.
Zinc promotes catch-up growth (specifically height gain) and immune recovery in malnourished children.

Side Effects: Acute ingestion of zinc supplements may occasionally cause gastrointestinal irritation, vomiting, or abdominal pain.
Interactions:
- Zinc supplements can interfere with iron absorption and vice versa. If both are required, doses should be staggered.
- However, in the management of diarrhea in SAM, iron is withheld during the stabilization phase (due to free radical risk), while zinc is started immediately.
Copper Deficiency: Chronic excess zinc intake can worsen copper deficiency. Therefore, in SAM management, copper is often supplemented alongside zinc.