Selenium toxicity: Difference between revisions

(Text replacement - "Poison Control Center" to "poison control")
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***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
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***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]]
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*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
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*No deaths from chronic exposures
*No deaths from chronic exposures
*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
*Alopecia with brittle hair
*[[Alopecia]] with brittle hair
*Fatigue
*[[Fatigue]]
*Nail deformities
*Nail deformities
*Pruritic scalp rash
*[[pruritus|Pruritic]] scalp [[rash]]
*Blistered skin with persistent red color
*Blistered skin with persistent red color
*Neurologic
*Neurologic
**Hyperreflexia
**Hyperreflexia
**Paresthesia
**[[Paresthesia]]
**Anesthesia
**[[numbness|Anesthesia]]
**Hemiplegia
**[[weakness|Hemiplegia]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Evaluation==
==Evaluation==
*BMP
*BMP
*LFTs
*[[LFTs]]
*CBC
*CBC
*CPK
*CPK
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*Urine < 0.03 mg/L (<0.38 μmol/L)
*Urine < 0.03 mg/L (<0.38 μmol/L)
*Hair < 0.4 μg/g (0.01 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]]
*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
==References==
==References==
<references/>
<references/>

Revision as of 20:26, 22 October 2019

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

References

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

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