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Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 JPEN+J+Parenter+Enteral+Nutr 2016 ; 40 (6): 860-8 Nephropedia Template TP
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A Safety and Dose-escalation Study of Intravenous Zinc Supplementation in Pediatric Critical Illness #MMPMID25700179
Cvijanovich NZ; King JC; Flori HR; Gildengorin G; Vinks AA; Wong HR
Background: Critically ill children have low plasma zinc (pZn), correlating with organ failure. Since Zn influences inflammation, immune function, and glucose control, Zn supplementation is a plausible therapeutic modality. We sought to determine a safe dose of IV Zn to restore pZn in critically ill children. Methods: Stepwise dose-escalation study of IV Zn supplementation at a tertiary children?s hospital. All children (<10 years) admitted to PICU with PRISM III score > 5 OR ? one new organ failure were eligible. After consent, patients were sequentially enrolled into 4 dosing groups: 1) No zinc, 2) Zn250: 250 ?g/kg/day ZnSO4, 3) Zn500: 500 ?g/kg/day ZnSO4, or 4) Zn750: 750 ?g/kg/day ZnSO4. ZnSO4 was administered 3 times daily for 7 days. pZn was measured at baseline, end of first ZnSO4 infusion, 1 hour post-infusion, and 7 hours post-infusion on Day 1, then daily trough Days 2?7. IL-6, CRP, and lymphocyte subsets were measured Days 1 and 3. Glucose was measured three times daily for 7 days. Results: 24 patients were enrolled. Baseline demographics were similar among groups. Baseline pZn was low in all patients (mean 41.8 ?g/dL, standard deviation ± 16.0). pZn increased over the study period in supplemented groups; however, mean pZn in the Zn750 group exceeded 50th percentile. pZn was not associated with IL-6, CRP, or lymphocyte subsets among groups. Degree of hyperglycemia did not differ among groups. No patient had a study-related adverse event. Conclusions: IV zinc supplementation at 500 ?g/kg/day restores pZn to near 50th percentile and is well tolerated.