経腸栄養による亜鉛欠乏症の1例 A Case of Zinc Deficiency Syndrome as a Complication of Enteral Nutrition

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63歳の男性の獲得性亜鉛欠乏症。食道癌による食道全摘術後約4カ月で中心静脈栄養から経腸栄養に変更したところ, 20日目頃より陰嚢に軽度のそう痒と疼痛を伴う皮疹が出現した。種々の外用剤に抵抗性で, 徐々に顔面・被髪頭部, 体幹・四肢へ拡大し, 易脱毛, 下痢の増強も認めるようになった。血清亜鉛濃度は9μg/dlと著明に低下しており, 経腸栄養剤には亜鉛が配合されていなかった。硫酸亜鉛の投与を行ったところ血清亜鉛濃度の回復とともに全身の皮疹は劇的に改善した。

The present case concerns a 63-year-old male with zinc deficiency syndrome caused by a zinc-poor enteral diet. Four months after a total esophagectomy for treatment of advanced esophageal cancer, the method of feeding the patient was changed from intravenous hyperalimentation to enteral feeding. Some 20 days following the commencement of enteral nutrition, the patient began exhibiting erosions and scaly erythema accompanied by itchiness and sharp pain in the scrotum. The condition resisted treatment with various types of topical medication and gradually spread to other areas of the body, including the face, scalp, abdomen, extremities, and the perianal area, and was accompanied by alopecia and severe diarrhea. The serum zinc level showed a marked drop to 9 μg/dl. It was subsequently found that the enteral diet formula, Hinex R, contained no zinc. Supplementation of the patient's diet with zinc sulfate resulted in a normalization of serum zinc concentrations and the rapid remission of symptoms over the entire body.

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  • 西日本皮膚科 = The Nishinihon journal of dermatology  

    西日本皮膚科 = The Nishinihon journal of dermatology 66(5), 466-469, 2004-10-01 

    Western Division of Japanese Dermatological Association

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