{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T18:10:36Z","timestamp":1790964636859,"version":"4.1.0"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951525101478_sec1a\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Zinc is a micronutrient essential for taste perception and may be prescribed for dysgeusia in cancer patients undergoing treatment. However, overconsumption of zinc can lead to copper deficiency, which is likely under-recognized and can present as fatigue, nausea, anemia, and myelopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525101478_sec2b\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A patient in his 70s with multiple myeloma and gastroparesis taking zinc supplementation to treat dysgeusia for the past 2\u00a0years presented with generalized fatigue, lightheadedness, nausea, neutropenia, anemia, gait disturbance, and worsening numbness and tingling in the bilateral lower extremities and hands. He was found to have hypocupremia in the setting of prolonged zinc supplementation and admitted for inpatient treatment with IV cupric chloride. His symptoms gradually improved over the course of approximately 5\u20136\u00a0weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525101478_sec3c\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinicians should be vigilant about screening for copper deficiency symptoms in patients taking zinc supplementation and avoid prolonged courses or overprescribing of zinc. Hypocupremia should be promptly diagnosed and treated to prevent permanent neurological deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951525101478","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T03:19:46Z","timestamp":1768533586000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Prolonged zinc use for dysgeusia causing copper deficiency"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9797-8926","authenticated-orcid":false,"given":"Min Ji","family":"Kim","sequence":"first","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-6136","authenticated-orcid":false,"given":"Michael Jay","family":"Tang","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bruera","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"S1478951525101478_ref13","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1177\/106002809603000215","article-title":"Zinc deficiency and taste disorders","volume":"30","author":"Heyneman","year":"1996","journal-title":"The Annals of Pharmacotherapy"},{"key":"S1478951525101478_ref1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1093\/ajcn\/44.5.664","article-title":"The effect of age on plasma zinc uptake and taste acuity","volume":"44","author":"Bales","year":"1986","journal-title":"American Journal of Clinical Nutrition"},{"key":"S1478951525101478_ref18","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.4065\/81.10.1371","article-title":"Copper deficiency myelopathy (human swayback)","volume":"81","author":"Kumar","year":"2006","journal-title":"Mayo Clinic Proceeding"},{"key":"S1478951525101478_ref19","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/jat.1263","article-title":"Zinc toxicity alters mitochondrial metabolism and leads to decreased ATP production in hepatocytes","volume":"28","author":"Lemire","year":"2008","journal-title":"Journal of Applied Toxicology: JAT"},{"key":"S1478951525101478_ref9","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/j.1600-0609.2008.01050.x","article-title":"Hematological manifestations of copper deficiency: a retrospective review","volume":"80","author":"Halfdanarson","year":"2008","journal-title":"European Journal of Haematology"},{"key":"S1478951525101478_ref22","doi-asserted-by":"crossref","first-page":"222.e221","DOI":"10.1016\/j.ajem.2023.08.033","article-title":"Severe copper deficiency anemia caused by zinc supplement use","volume":"72","author":"Magham","year":"2023","journal-title":"The American Journal of Emergency Medicine."},{"key":"S1478951525101478_ref29","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3390\/diseases12060130","article-title":"Taste and Smell Alterations (TSAs) in cancer patients","volume":"12","author":"Rosati","year":"2024","journal-title":"Diseases"},{"key":"S1478951525101478_ref11","first-page":"7271","article-title":"Polaprezinc prevents oral mucositis in patients treated with high-dose chemotherapy followed by hematopoietic stem cell transplantation","volume":"34","author":"Hayashi","year":"2014","journal-title":"Anticancer Research"},{"key":"S1478951525101478_ref17","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/jn\/120.suppl_11.1474","article-title":"Assessment of zinc status","volume":"120","author":"King","year":"1990","journal-title":"Journal of Nutrition"},{"key":"S1478951525101478_ref20","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s00520-025-09484-9","article-title":"Correlation between taste and smell alterations and quality of life in patients treated with radiotherapy for nasopharyngeal carcinoma: a cross-sectional study in China","volume":"33","author":"Liang","year":"2025","journal-title":"Supportive Care in Cancer"},{"key":"S1478951525101478_ref32","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/0030-4220(84)90256-1","article-title":"Serum zinc and copper in oral\/oropharyngeal carcinoma. A study of seventy-five patients","volume":"57","author":"Silverman","year":"1984","journal-title":"Oral Surgery, Oral Medicine, Oral Pathology"},{"key":"S1478951525101478_ref24","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/978-3-319-60189-2_15","article-title":"Neurotoxicity of Zinc","volume":"18","author":"Morris","year":"2017","journal-title":"Advances in Neurobiology"},{"key":"S1478951525101478_ref15","doi-asserted-by":"crossref","first-page":"5351","DOI":"10.1007\/s00520-022-06936-4","article-title":"Multicenter, prospective, observational study of chemotherapy-induced dysgeusia in gastrointestinal cancer","volume":"30","author":"Ito","year":"2022","journal-title":"Supportive Care in Cancer"},{"key":"S1478951525101478_ref35","first-page":"557","article-title":"The pilot trial of the prevention of the increase in electrical taste thresholds by zinc containing fluid infusion during chemotherapy to treat primary lung cancer","volume":"22","author":"Yamagata","year":"2003","journal-title":"Journal of Experimental and Clinical Cancer Research: CR"},{"key":"S1478951525101478_ref12","doi-asserted-by":"crossref","first-page":"318","DOI":"10.2165\/00002018-199411050-00004","article-title":"Drug-induced taste and smell disorders. 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e37"}}