Selenium toxicity: Difference between revisions

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*Deficiency found to be the cause of Keshan disease and Kashin-beck disease
*Deficiency found to be the cause of Keshan disease and Kashin-beck disease
*Recommended daily dose is 5 μg/d
*Recommended daily dose is 5 μg/d
*Uses
 
**Gun bluing solution
===Uses===
**Dietary supplement
*Gun bluing solution
**Antidandruff shampoo
*Dietary supplement
**Glass decolorizer and manufacturing
*Antidandruff shampoo
**Insecticide
*Glass decolorizer and manufacturing
**Vulcanization of rubber
*Insecticide
**Used in copper refineries  
*Vulcanization of rubber
==Toxicokinetics==
*Used in copper refineries  
 
===Toxicokinetics===
*Cofactor in glutathione peroxidase
*Cofactor in glutathione peroxidase
*Varied GI absorption
*Varied GI absorption
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**Selenious acid
**Selenious acid
*Limited data on toxicokinetics as it varies amongst compounds
*Limited data on toxicokinetics as it varies amongst compounds
==Clinical Features==
==Clinical Features==
*'''Acute'''
===Acute===
**Oral exposure
*Oral exposure
***'''Triphasic course'''
**'''Triphasic course'''
***Rapid and fulminant
**Rapid and fulminant
****Symptoms can occur within minutes and death can occur with 1-4 hours
***Symptoms can occur within minutes and death can occur with 1-4 hours
***'''GI'''
**'''GI'''
****Abdominal pain
***[[Abdominal pain]]
****Diarrhea
***[[Diarrhea]]
****Nausea and vomiting
***[[Nausea and vomiting]]
****Caustic esophageal and gastric burns
***Caustic esophageal and gastric burns
****Some patients have a garlic odor
***Some patients have a garlic odor
***'''Myopathic'''
**'''Myopathic'''
****Weakness
***[[Weakness]]
****Hyporeflexia
***Hyporeflexia
****Myoclonus
***Myoclonus
****Fasciculations
***Fasciculations
****Elevated CPK
***Elevated CPK
****Renal insufficiency
***Renal insufficiency
****Delirium and coma
***[[Delirium]] and [[coma]]
***'''Circulatory symptoms'''
**'''Circulatory symptoms'''
****Dyspnea
***[[Dyspnea]]
****Chest pain
***[[Chest pain]]
****Tachycardia
***[[Tachycardia]]
****Hypotension
***[[Hypotension]]
*****Toxic cardiomyopathy
****Toxic [[cardiomyopathy]]
****[[EKG]] abnormalities
***[[EKG]] abnormalities
*****[[ST elevation]]
****[[ST elevation]]
*****[[Prolonged QT]]
****[[Prolonged QT]]
*****[[T wave inversions]]
****[[T wave inversions]]
****[[Pulmonary edema]]
***[[Pulmonary edema]]
****[[Ventricular dysrhythmias]]
***[[Ventricular dysrhythmias]]
****[[Myocardial infarction]]
***[[Myocardial infarction]]
****[[Mesenteric infarction]]
***[[Mesenteric infarction]]
****[[Metabolic acidosis]]
***[[Metabolic acidosis]]
**Inhalation
*Inhalation
***Hydrogen selenide
**Hydrogen selenide
****Throat and eye pain
***[[sore throat|Throat]] and [[eye pain]]
****Rhinorrhea
***[[Rhinorrhea]]
****Wheezing
***[[Wheezing]]
****Pneumomediastium
***[[Pneumomediastinum]]
****Restrictive and obstructive pulmonary disease
***Restrictive and obstructive pulmonary disease
***Selenium dioxide and selenium oxide
**Selenium dioxide and selenium oxide
****Forms selenius acid in presence of water in respiratory tract
***Forms selenius acid in presence of water in respiratory tract
****Bronchospasm
***Bronchospasm
****Hypotension
***[[Hypotension]]
****Tachycardia
***[[Tachycardia]]
****Tachypnea
***[[Tachypnea]]
****Chemical pneumonitis
***Chemical [[pneumonitis]]
****Fevers
***[[Fever]]s
****Vomiting and diarrhea
***[[Vomiting]] and [[diarrhea]]
**Dermal
*Dermal
***Caustic burns
**[[Caustic burns]]
**Ophthalmic
*Ophthalmic
***Corneal injuries
**[[caustic eye exposure|Corneal injuries]]
***Lacrimation
**Lacrimation
***Conjunctival edema
**Conjunctival edema
*'''Chronic or Selenosis'''
 
**No deaths from chronic exposures
===Chronic or Selenosis===
**Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
*No deaths from chronic exposures
**Alopecia with brittle hair
*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
**Fatigue
*[[Alopecia]] with brittle hair
**Nail deformities
*[[Fatigue]]
**Pruritic scalp rash
*Nail deformities
**Blistered skin with persistent red color
*[[pruritus|Pruritic]] scalp [[rash]]
**Neurologic
*Blistered skin with persistent red color
***Hyperreflexia
*Neurologic
***Paresthesia
**Hyperreflexia
***Anesthesia
**[[Paresthesia]]
***Hemiplegia
**[[numbness|Anesthesia]]
**[[weakness|Hemiplegia]]
 
==Differential Diagnosis==
==Differential Diagnosis==
===[[Heavy metal]] toxicity===
{{Heavy metals list}}
*[[Aluminum toxicity]]
 
*[[Antimony toxicity]]
*[[Arsenic toxicity]]
*[[Barium toxicity]]
*[[Bismuth toxicity]]
*[[Cadmium toxicity]]
*[[Chromium toxicity]]
*[[Cobalt toxicity]]
*[[Copper toxicity]]
*[[Gold toxicity]]
*[[Iron toxicity]]
*[[Lead toxicity]]
*[[Lithium toxicity]]
*[[Manganese toxicity]]
*[[Mercury toxicity]]
*[[Nickel toxicity]]
*[[Phosphorous toxicity]]
*[[Platinum toxicity]]
*[[Selenium toxicity]]
*[[Silver toxicity]]
*[[Thallium toxicity]]
*[[Tin toxicity]]
*[[Zinc toxicity]]
==Evaluation==
==Evaluation==
*BMP
*BMP
*LFTs
*[[LFTs]]
*CBC
*CBC
*CPK
*CPK
*EKG
*EKG
*Thyroid function tests
*Thyroid function tests
*Whole blood = 0.1–0.34 mg/L (1.27–4.32 μmol/L)
*Serum = 0.04–0.6 mg/L (0.51–7.6 μmol/L)
*Urine < 0.03 mg/L (<0.38 μmol/L)
*Hair < 0.4 μg/g (0.01 μmol/L)
==Management==
==Management==
*Decontamination
**Irrigation for dermal exposures
**Consider activated charcoal or oral gastric lavage in cases that could produce significant toxicity
**Selenious acid
***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
*Consult Toxicology or [[poison control]]
*Supportive care
*Supportive care
**Mainstay of treatment
**Mainstay of treatment
**Acute toxicities usually require multi system support
**Acute toxicities usually require multi system support
*Pain management
*[[analgesia|Pain management]]
**10% sodium thiosulfate solution/ointment to skin, nail, and eyes
**10% sodium thiosulfate solution/ointment to skin, nail, and eyes
***Relief of pain by reduction of selenium dioxide to elemental selenium
***Relief of pain by reduction of selenium dioxide to elemental selenium
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***Calcium gluconate gel
***Calcium gluconate gel
****Same treatment as hydrofluoric acid exposures
****Same treatment as hydrofluoric acid exposures
*Decontamination
**Irrigation for dermal exposures
**Consider activated charcoal or oral gastric lavage in cases that could produce significant toxicity
**Selenious acid
***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
*Chelation
*Chelation
**[[Dimercaprol]], [[CaNa<sub>2</sub>EDTA]], or [[Succimer]] may form nephrotoxic complexes and worsen toxicity
**[[Dimercaprol]], CaNa<sub>2</sub>[[EDTA]], or [[Succimer]] may form nephrotoxic complexes and worsen toxicity


==Disposition==
==Disposition==
*Consult Toxicology or Poison Control Center
*Acute toxicities will likely require ICU level of care
*Acute toxicities will likely require ICU level of care
*Chronic exposures are likely safe for discharge and outpatient follow up
*Chronic exposures are likely safe for discharge and outpatient follow up
==See Also==
*[[Toxicology (main)]]
==References==
==References==
<references/>
<references/>

Latest revision as of 21:21, 8 March 2021

Background

  • Essential trace element
  • Deficiency found to be the cause of Keshan disease and Kashin-beck disease
  • Recommended daily dose is 5 μg/d

Uses

  • Gun bluing solution
  • Dietary supplement
  • Antidandruff shampoo
  • Glass decolorizer and manufacturing
  • Insecticide
  • Vulcanization of rubber
  • Used in copper refineries

Toxicokinetics

  • Cofactor in glutathione peroxidase
  • Varied GI absorption
  • Minimal dermal absorption
  • Bioavailability (Lowest - Highest)
    • Elemental selenium
    • Inorganic selenite and selenate salt
    • Selenious acid
  • Limited data on toxicokinetics as it varies amongst compounds

Clinical Features

Acute

Chronic or Selenosis

  • No deaths from chronic exposures
  • Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
  • Alopecia with brittle hair
  • Fatigue
  • Nail deformities
  • Pruritic scalp rash
  • Blistered skin with persistent red color
  • Neurologic

Differential Diagnosis

Evaluation

  • BMP
  • LFTs
  • CBC
  • CPK
  • EKG
  • Thyroid function tests
  • Whole blood = 0.1–0.34 mg/L (1.27–4.32 μmol/L)
  • Serum = 0.04–0.6 mg/L (0.51–7.6 μmol/L)
  • Urine < 0.03 mg/L (<0.38 μmol/L)
  • Hair < 0.4 μg/g (0.01 μmol/L)

Management

  • Decontamination
    • Irrigation for dermal exposures
    • Consider activated charcoal or oral gastric lavage in cases that could produce significant toxicity
    • Selenious acid
      • Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
  • Consult Toxicology or poison control
  • Supportive care
    • Mainstay of treatment
    • Acute toxicities usually require multi system support
  • Pain management
    • 10% sodium thiosulfate solution/ointment to skin, nail, and eyes
      • Relief of pain by reduction of selenium dioxide to elemental selenium
    • Selenium hexafluoride gas exposures
      • Calcium gluconate gel
        • Same treatment as hydrofluoric acid exposures
  • Chelation

Disposition

  • Acute toxicities will likely require ICU level of care
  • Chronic exposures are likely safe for discharge and outpatient follow up

See Also

References

Calellor, D. Selenium. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1316-1320

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