BNF for Children 2011-2012

478 9.5.4 Zinc BNFC 2011–20129 Nutrition and bloodDuraphat c ‘5000 ppm’ toothpaste, sodium fluoride1.1%. Net price 51 g = £6.50. Counselling, see belowDoseChild over 16 years apply 2 cm 3 times daily after mealsusing a toothbrushCounselling Brush teeth for 3 minutes before spitting outDental prescribing on NHS May be prescribed as SodiumFluoride Toothpaste 1.1%9.5.4 ZincZinc supplements should not be given unless there isgood evidence of deficiency (hypoproteinaemia spuriouslylowers plasma-zinc concentration) or in zinclosingconditions. Zinc deficiency can occur as a resultof inadequate diet or malabsorption; excessive loss ofzinc can occur in trauma, burns, and protein-losingconditions. A zinc supplement is given until clinicalimprovement occurs, but it may need to be continuedin severe malabsorption, metabolic disease, or in zinclosingstates. Zinc is used in the treatment of Wilson’sdisease (section 9.8.1) and acrodermatitis enteropathica,a rare inherited abnormality of zinc absorption.Parenteral nutrition regimens usually include traceamounts of zinc (section 9.3). If necessary, further zinccan be added to some intravenous feeding regimens.ZINC SULPHATECautions interactions: Appendix 1 (zinc)Renal impairment accumulation may occur in acuterenal failurePregnancy crosses placenta; risk theoretically minimal,but no information availableBreast-feeding present in milk; risk theoreticallyminimal, but no information availableSide-effects abdominal pain, dyspepsia, nausea,vomiting, diarrhoea, gastric irritation, gastritis; irritability,headache, lethargyLicensed use Solvazinc c not licensed for use inacrodermatitis enteropathicaSolvazinc c (Galen)Effervescent tablets, zinc sulphate monohydrate125 mg (45 mg zinc), net price 30 = £4.32. Label: 13,21DoseZinc deficiency (see notes above). By mouthNeonate 1 mg/kg elemental zinc dailyChild under 10 kg half a tablet daily in water after food,adjusted as necessaryChild 10–30 kg half a tablet 1–3 times daily in waterafter food, adjusted as necessaryChild over 30 kg 1 tablet 1–3 times daily in water afterfood, adjusted as necessaryAcrodermatitis enteropathica. By mouthNeonate 0.5–1 mg/kg elemental zinc twice daily (totaldaily dose may alternatively be given in 3 divided doses),adjusted as necessaryChild 1 month–18 years 0.5–1 mg/kg elemental zinctwice daily (total daily dose may alternatively be given in3 divided doses), adjusted as necessary9.6 Vitamins9.6.1 Vitamin A9.6.2 Vitamin B group9.6.3 Vitamin C9.6.4 Vitamin D9.6.5 Vitamin E9.6.6 Vitamin K9.6.7 Multivitamin preparationsVitamins are used for the prevention and treatment ofspecific deficiency states or where the diet is known tobe inadequate; they may be prescribed in the NHS toprevent or treat deficiency but not as dietary supplements.Except for iron-deficiency anaemia, a primaryvitamin or mineral deficiency due to simple dietaryinadequacy is rare in the developed world. Some childrenmay be at risk of developing deficiencies becauseof an inadequate intake, impaired vitamin synthesis ormalabsorption in disease states such as cystic fibrosisand Crohn’s disease.The use of vitamins as general ‘pick-me-ups’ is ofunproven value and the ‘fad’ for mega-vitamin therapywith water-soluble vitamins, such as ascorbic acid andpyridoxine, is unscientific and can be harmful. Manyvitamin supplements are described as ‘multivitamin’ butfew contain the whole range of essential vitamins andmany contain relatively high amounts of vitamins A andD. Care should be taken to ensure the correct dose is notexceeded.Dietary reference values for vitamins are available in theDepartment of Health publication:Dietary Reference Values for Food Energy and Nutrients forthe United Kingdom: Report of the Panel on Dietary ReferenceValues of the Committee on Medical Aspects of FoodPolicy. Report on Health and Social Subjects 41. London:HMSO, 1991Dental patients It is unjustifiable to treat stomatitis orglossitis with mixtures of vitamin preparations; thisdelays diagnosis and correct treatment.Most patients who develop a nutritional deficiencydespite an adequate intake of vitamins have malabsorptionand if this is suspected the patient should bereferred to a medical practitioner.9.6.1 Vitamin ADeficiency of vitamin A (retinol) is associated withocular defects (particularly xerophthalmia) and anincreased susceptibility to infections, but deficiency israre in the UK (even in disorders of fat absorption).Vitamin A supplementation may be required in childrenwith liver disease, particularly cholestatic liver disease,due to the malabsorption of fat soluble vitamins. Inthose with complete biliary obstruction an intramusculardose once a month may be appropriate.Treatment is sometimes initiated with very high dosesof vitamin A and the child should be monitored closely;very high doses are associated with acute toxicity.