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Acute Selenium Toxicity Associated With a Dietary Supplement

2010; American Medical Association; Volume: 170; Issue: 3 Linguagem: Inglês

10.1001/archinternmed.2009.495

1538-3679

Jennifer MacFarquhar, Danielle L. Broussard, Paul Melstrom, Richard W. Hutchinson, Amy Wolkin, Colleen Martin, Raymond F. Burk, John R. Dunn, A Green, Roberta M. Hammond, William Schaffner, Timothy F. Jones,

Pesticide Exposure and Toxicity

Background: Selenium is an element necessary for normal cellular function, but it can have toxic effects at high doses.We investigated an outbreak of acute selenium poisoning.Methods: A case was defined as the onset of symptoms of selenium toxicity in a person within 2 weeks after ingesting a dietary supplement manufactured by "Company A," purchased after January 1, 2008.We conducted case finding, administered initial and 90-day follow-up questionnaires to affected persons, and obtained laboratory data where available. Results:The source of the outbreak was identified as a liquid dietary supplement that contained 200 times the labeled concentration of selenium.Of 201 cases identified in 10 states, 1 person was hospitalized.The median estimated dose of selenium consumed was 41 749 µg/d (rec-ommended dietary allowance is 55 µg/d).Frequently reported symptoms included diarrhea (78%), fatigue (75%), hair loss (72%), joint pain (70%), nail discoloration or brittleness (61%), and nausea (58%).Symptoms persisting 90 days or longer included fingernail discoloration and loss (52%), fatigue (35%), and hair loss (29%).The mean initial serum selenium concentration of 8 patients was 751 µg/L (reference range, Յ125 µg/L).The mean initial urine selenium concentration of 7 patients was 166 µg/24 h (reference range, Յ55 µg/24 h).Conclusions: Toxic concentrations of selenium in a liquid dietary supplement resulted in a widespread outbreak.Had the manufacturers been held to standards used in the pharmaceutical industry, it may have been prevented.