The shortages of intravenous drugs remains critical, with sterile injectables accounting for 80% of the approximately 300 shortages. The impact is being felt in patients dependent on parenteral nutrition (PN), and severe deficiencies are becoming more commonplace. We report here a man who developed severe zinc deficiency, manifesting as a painful desquamative rash, due to an inability to obtain multi–trace element additives for his PN.
PramyothinPKimDWYoungLSWichansawakunSApovianCM. Anemia and leukopenia in a long-term parenteral nutrition patient during a shortage of parenteral trace element products in the United States. JPEN J Parenter Enteral Nutr. 2013;37(3):425-429.
9.
Centers for Disease Control and Prevention (CDC). Notes from the field: zinc deficiency dermatitis in cholestatic extremely premature infants after a nationwide shortage of injectable zinc—Washington, DC, December 2012. MMWR Morb Mortal Wkly Rep. 2013;62(7):136-137.
10.
RuktanonchaiDLoweMNortonS. Zinc deficiency-associated dermatitis in infants during a nationwide shortage of injectable zinc—Washington, DC, and Houston, Texas 2012-2013. MMWR Morb Mortal Wkly Rep. 2014;63(2):35-37.
11.
PalmEDotsonB. Copper and zinc deficiency in a patient receiving long-term parenteral nutrition during a shortage of parenteral trace element products [published online September4, 2014]. JPEN J Parenter Enteral Nutr.
12.
FranckAJ. Zinc deficiency in a parenteral nutrition–dependent patient during a parenteral trace element product shortage. JPEN J Parenter Enteral Nutr. 2014;38(5):637-639.
13.
DavisCJavidPJHorslenS. Selenium deficiency in pediatric patients with intestinal failure as a consequence of drug shortage. JPEN J Parenter Enteral Nutr. 2014;38(1):115-118.
14.
PrasadAS. Clinical, endocrinological and biochemical effects of zinc deficiency. Clin Endocrinol Metab. 1985;14(3):567-589.
15.
KayRGTasman-JonesCPybusJWhitingRBlackH. A syndrome of acute zinc deficiency during total parenteral alimentation in man. Ann Surg. 1976;183(4):331-340.
16.
OkadaATakagiYItakuraTSataniMManabeH. Skin lesions during intravenous hyperalimentation: zinc deficiency. Surgery. 1976;80(5):629-635.
17.
Guidelines for essential trace element preparations for parenteral use: a statement by an expert panel. JAMA. 1979;241(19):2051-2054.
18.
Guidelines for essential trace element preparations for parenteral use: a statement by the Nutrition Advisory Group. American Medical Association. JPEN J Parenter Enteral Nutr. 1979;3(4):263-267.
19.
GonzalezJRBotetMVSanchezJL. The histopathology of acrodermatitis enteropathica. Am J Dermatopathol. 1982;4(4):303-311.
HassigTBMcKinzieBPFortierCRTaberD. Clinical management strategies and implications for parenteral nutrition drug shortages in adult patients. Pharmacotherapy. 2014;34(1):72-84.
