Which deficiency may occur with biliary atresia, chronic malnutrition, cirrhosis and chronic stress that is difficult to assess and detect due to laboratory limitations?

• A. Iron
• B. Zinc
• C. Copper
• D. Selenium

Answer: (B)

Zinc status is notoriously hard to gauge in patients with biliary atresia, chronic malnutrition, cirrhosis, and chronic stress because serum zinc levels do not reliably mirror total body zinc stores. Serum zinc is influenced by inflammation, the acute-phase response, meals, and daily fluctuations, and there is no universally accepted gold-standard test for zinc deficiency. In liver disease, cholestasis and malabsorption further complicate the picture, so laboratory measurements can fail to detect a deficiency until symptoms appear. Because of these limitations, zinc deficiency is a common concern in these conditions, and clinicians often rely on clinical signs and response to zinc supplementation rather than solely on lab values.