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 Table of Contents    
Year : 2022  |  Volume : 54  |  Issue : 3  |  Page : 236-237

Oral zinc-induced vomiting in children with acute gastroenteritis. Should we switch to low-dose zinc?

Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India

Date of Submission02-Sep-2021
Date of Decision24-Mar-2022
Date of Acceptance14-Jun-2022
Date of Web Publication12-Jul-2022

Correspondence Address:
Dr. Thirunavukkarasu Arun Babu
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijp.ijp_706_21

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How to cite this article:
Babu TA. Oral zinc-induced vomiting in children with acute gastroenteritis. Should we switch to low-dose zinc?. Indian J Pharmacol 2022;54:236-7

How to cite this URL:
Babu TA. Oral zinc-induced vomiting in children with acute gastroenteritis. Should we switch to low-dose zinc?. Indian J Pharmacol [serial online] 2022 [cited 2022 Aug 12];54:236-7. Available from: https://www.ijp-online.com/text.asp?2022/54/3/236/350707

The World Health Organization recommends routine supplementation of oral zinc as a simple and very efficacious intervention in the clinical management of children with acute diarrhea.[1] Zinc is given for 10–14 days at a dose of 20 mg per day for kids above 6 months and at 10 mg per day for those with age below 6 months[1],[2] The role of zinc in pediatric acute diarrheal disease has been irrefutably established by numerous trials.[3],[4] A Cochrane systematic review on this topic has concluded that oral zinc supplementation may benefit children aged 6 months or above with acute diarrhea in areas with a high prevalence of zinc deficiency and malnutrition.[3] It also found no evidence to support its use in children below 6 months, especially in children who are well-nourished and children with a lower risk of developing zinc deficiency.[3]

One of the most common problems with oral zinc therapy in children with acute diarrhea is the higher incidence of vomiting and nausea.[4],[5] Studies have shown up to 50% increased risk of nausea and vomiting after the initial dose of zinc.[3],[4] Strong metallic taste and gastric irritation are the proposed mechanisms for this adverse effect.[5] Oral zinc-induced vomiting is, however, transient and occurs within half an hour of initiating therapy. It is hypothesized to arise due to a centrally-acting, mild neuronal reflex, secondary to zinc-induced metallic taste.[3],[4] Zinc can also worsen vomiting which is a common primary symptom of acute gastroenteritis. Oral zinc can lead to worsening of clinical status and dehydration requiring intravenous fluids, especially common during the “acute phase” of gastroenteritis. A systematic review of 12 trials including a total of 5189 children with acute diarrhea found that there was significantly higher risk of vomiting with zinc supplementation compared to placebo (risk ratio of 1.59 and 95% confidence interval of 1.27–1.89).[3] Many clinicians now defer oral zinc during the acute phase when nausea and vomiting are predominant.

A recently published trial by Dhingra et al. has addressed this very critical issue of using low-dose zinc in children with diarrhea.[5] This randomized control trial has concluded that low-dose zinc at 5–10 mg/day was noninferior to the full dose of 20 mg for 14 days in terms of duration of diarrhea, number of stools, and superior in terms of reduced vomiting. This study raises serious questions regarding whether we should continue to give high dose (20 mg/day) of zinc despite the known menace of vomiting. It would be prudent to examine the available evidence on using “low-dose” zinc in children with diarrhea and change the guidelines accordingly.

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There are no conflicts of interest.

  References Top

World Health Organization, Khan WU, Sellen DW. Zinc Supplementation in the Management of Diarrhoea. Available from: https://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Last accessed on 2021 Aug 23].  Back to cited text no. 1
Babu TA. The ideal zinc preparation in the management of acute diarrhea in children. Indian J Pharmacol 2013;45:539.  Back to cited text no. 2
[PUBMED]  [Full text]  
Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev 2012;6:CD005436.  Back to cited text no. 3
Patel A, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni H. Therapeutic value of zinc supplementation in acute and persistent diarrhea: A systematic review. PLoS One 2010;5:e10386.  Back to cited text no. 4
Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, Dutta A, et al. Lower-dose zinc for childhood diarrhea – A randomized, multicenter trial. N Engl J Med 2020;383:1231-41.  Back to cited text no. 5


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