Selenium toxicity
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
- Oral exposure
- Triphasic course
- Rapid and fulminant
- Symptoms can occur within minutes and death can occur with 1-4 hours
- GI
- Abdominal pain
- Diarrhea
- Nausea and vomiting
- Caustic esophageal and gastric burns
- Some patients have a garlic odor
- Myopathic
- Weakness
- Hyporeflexia
- Myoclonus
- Fasciculations
- Elevated CPK
- Renal insufficiency
- Delirium and coma
- Circulatory symptoms
- Dyspnea
- Chest pain
- Tachycardia
- Hypotension
- Toxic cardiomyopathy
- EKG abnormalities
- Pulmonary edema
- Ventricular dysrhythmias
- Myocardial infarction
- Mesenteric infarction
- Metabolic acidosis
- Inhalation
- Hydrogen selenide
- Throat and eye pain
- Rhinorrhea
- Wheezing
- Pneumomediastium
- Restrictive and obstructive pulmonary disease
- Selenium dioxide and selenium oxide
- Forms selenius acid in presence of water in respiratory tract
- Bronchospasm
- Hypotension
- Tachycardia
- Tachypnea
- Chemical pneumonitis
- Fevers
- Vomiting and diarrhea
- Hydrogen selenide
- Dermal
- Caustic burns
- Ophthalmic
- Corneal injuries
- Lacrimation
- Conjunctival edema
- Oral exposure
Differential Diagnosis
Heavy metal toxicity
- 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
Management
Disposition
- Consult Toxicology or Poison Control Center
References
Calellor, D. Selenium. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1316-1320