Zinc in Treatment of Diarrhoea in Children


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  • Zinc Sulfate is the most cost-effective
  • Enzymes : alkaline phosphatase, superoxide dismustase, etc, etc
  • Diet rich in Zn includes red meat, oysters, beef, chicken, cheese,(Chron’s Disease, Ulcerative Colitis)-MalabsorbtionGatrointestinal diseases
  • Bcl 2 gene is a proto-oncogene that prevents cells from apoptosis and many other pathways of death….it is expressed less is precursor lymphocytes…as they have 90% chance of developing non-sense clones and hence must be removed apoptically.Highly expressed bcl gene prevents opening of mitochondrial pores from where cytochrome c is released, which activates proteases and caspases
  • In secretory diarrhoea
  • Zinc in Treatment of Diarrhoea in Children

    1. 1. Role of Zincin Anti-DiarrhealTherapy inChildhoodDiarrhea Samyek Napit Roll no. 66 NAIHS-COM
    2. 2. • World Health Organization(WHO) and United Nations Children’s Emergency Fund recommends that all children with acute diarrheal illness should be treated with Zinc, “regardless of etiology”. Zinc reduces severity, duration and recurrence in ensuing 2-3 months.
    3. 3. For children <6 monthsof age10 mg Zinc for 10-14days should be givendailyFor children >6 monthsof age up to 5 yrs20 mg Zinc for 10-14days daily
    4. 4. • Zinc tablets are available in the following forms :- Zinc Sulfate Zinc Acetate Zinc Gluconate
    5. 5. Role of ZincZinc is an importantmicro-nutrient.Age Group Recommended Dietary Allowance0-6 months 2 mg7-12 months 3 mg1-3 yrs 3 mg4-8 yrs 5 mg Over 300 biological9-13 yrs 8 mg functions, functioning of14-18 yrs 11 mg(m) 9 mg(f) more than 100 enzymes Mother’s milk provides the19+ 11 mg(m) required 2mg of zn
    6. 6. Role of Zinc• for protein synthesis, cell growth and differentiation• immune function• maintaining cell membrane integrity (Bettger and Odell 1993).• intestinal transport of fluid and electrolyte??• is component of enzymes like carbonic anhydrase, alcohol dehydrogenase, etc
    7. 7. Zinc Deficiency• Zinc deficiency is a common among children in underdeveloped and developing countries.Causeso Low intake of diet rich in Zinco Lack of breast-feedingo Excess intake of legumes and whole grains- rich in phytates which inhibit Zinc absorption (among vegetarians)
    8. 8. Causes..o Chronic Diarrhoeao Malabsorbtiono Other Gastrointestinal diseases
    9. 9. Effects of Zinc deficiency• impaired immune function• diarrhea• growth retardation• Impairment of sexual development• loss of appetite
    10. 10. • eye and skin lesions• Weight loss• delayed healing of wounds• taste abnormalities/ impairment in development of taste buds (gustin)• mental lethargy
    11. 11. Effect of Zinc deficiency on immune system• rapid and extensive effect• promotes production of glucocorticoids from adrenal gland acting via hypothalamus and pituitary• glucocorticoid mediated apoptosis• results in loss of precursor lymphocytes( less bcl2 gene expression)
    12. 12. • down regulation of Lymphopoiesis• loss in antibody mediated response
    13. 13. How does Zinc help in diarrhoea?• Zinc supplementation + ORS stops diarrhoea faster *• Prevent reoccurrence of diarrhoea in the following months *Clear beneficial effects seen among infants > 6• Prevents months aforementioned problems due to Zinc Applicable in both acute deficiency and Chronic diarrhea
    14. 14. Mechanism•Zinc inhibits cAMP induced, chlorine dependent fluidsecretion•Zinc inhibits basolateral K+ channels•Boosts the immune system•Increases the absorption of water and electrolytes????
    15. 15. • Inhibits toxin induced cholera• As an adjunct to antimicrobial (AM) treatment in bloody dysentery showed increase in the bactericidal antibody titers against Shigella• Increases the levels of brush border enzymes• Increases intestinal epithelium regeneration
    16. 16. Cost of Management• Also, studies have shown that the use of Zinc therapy reduces the overall cost of management of diarrhea• Make ORS therapy more cost-effective
    17. 17. FOR 10-14 DAYS!• http://www.youtube.com/watch?v=8cpzCPtZ woU
    18. 18. References• “Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state” by Sarmila Mazumder a, Sunita Taneja a, Nita Bhandari a, Brinda Dube a, RC Agarwal b, Dilip Mahalanabis c, Olivier Fontaine d & Robert E Black e Bulletin of the World Health Organization 2010;88:754-760. doi: 10.2471/BLT.10.075986• The Dynamic Link between the Integrity of the Immune System and Zinc Status by Pamela J. Fraker, Louis E. King, Tonya Laako, Teresa L. Vollmer (American Society for Nutritional Sciences)• Role of Zinc in pediatric diarrhea- Indian Journal of Pharmacology
    19. 19. Thank You!