PEDIATRICS Vol. 69 No. 6 June 1982, pp. 773-777
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Zinc Dependency as a Cause of Chronic Diarrhea in Variant Acrodermatitis Enteropathica

Ingeborg Krieger MD1, Gary W. Evans PhD1, and Patricia S. Zelkowitz MD1

1 Department of Pediatrics, Wayne State University, School of Medicine, and Children's Hospital of Michigan, Detroit; United States Department of Agriculture Science and Education Administration, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota; and Kalamazoo, Michigan

Two siblings with chronic diarrhea, growth failure, mood changes, and occasional cheilosis responded repeatedly to treatment with either pharmacologic doses of zinc or pancreatin (Viokase), and their symptoms were exacerbated after withdrawal of therapy. Pancreatic exocrine deficiency was ruled out in both cases. Proteolytic activity was 20% of normal in one infant tested. Plasma zinc concentration was normal. Plasma picolimc acid concentration was low in these two patients and in one previously reported patient (mean 3.6, normal 12.4 ± 3.3 µmoles/liter). This is a characteristic shared with acrodermatitis enteropathica. The response to Viokase may be due to its content of picolinic acid and/or zinc or the correction of a deficiency of carboxypeptidase, a zinc requiring enzyme.

Submitted on October 12, 1981
Accepted on December 22, 1981


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