What are the symptoms of selenium deficiency?

Symptoms of Selenium Deficiency

Selenium deficiency manifests primarily as muscle weakness, cardiomyopathy, impaired immune function, and skin/hair changes, with severe cases potentially causing fatal heart failure. 1

Primary Clinical Manifestations

Musculoskeletal Symptoms

• Muscle weakness and pain (most common presentation) 1, 2
• Proximal muscle weakness 2
• Elevated creatine kinase (CK) levels 3, 2
• Profound fatigue 2, 4

Dermatological Changes

• Depigmentation of skin and hair (pseudoalbinism) 5, 3
• Hair color lightening (dark hair becoming blonde) 3
• Dry skin with irregularly shaped erythematous changes 6
• Poor wound healing 5

Cardiovascular Manifestations

• Cardiomyopathy (Keshan disease in severe cases) 1, 6
• Cardiac arrhythmias 1
• Heart failure (in advanced cases) 1

Hematological Abnormalities

• Erythrocyte macrocytosis (enlarged red blood cells) 5, 3
• Anemia (in some cases) 5

Neurological Symptoms

• Paresthesia (abnormal sensations) 1
• Peripheral neuropathy 2

Immune System Effects

• Increased susceptibility to viral infections 1
• Increased virulence of viral infections 1
• Impaired immune function 1, 7

Other Symptoms

• Glossitis (inflammation of the tongue) 5
• Taste changes 5
• Increased risk of infections 1, 7

High-Risk Populations

Selenium deficiency is particularly common in:

1. Patients on long-term parenteral nutrition without selenium supplementation 5, 1, 3
2. Patients on enteral nutrition with products low in selenium 1
3. Patients with malabsorption disorders 2
4. Individuals living in selenium-deficient geographical regions 1, 8
5. Patients with chronic kidney disease and those on dialysis 7
6. Patients with severe burns or on continuous renal replacement therapy 1
7. Patients after bariatric surgery, especially malabsorptive procedures 5
8. Chronic alcohol abusers 2
9. HIV-infected patients 2

Diagnostic Considerations

• Plasma selenium <0.4 μmol/L (<32 μg/L) indicates definite deficiency requiring immediate supplementation 5, 1
• Reduced glutathione peroxidase activity in plasma and red blood cells is a marker of selenium deficiency 5, 1
• Inflammation significantly affects selenium levels, so CRP must be measured simultaneously 5, 1
• CRP levels of 10-40,41-80, and >80 mg/L can reduce plasma selenium by 15-25%, 35%, and 50% respectively 5

Common Pitfalls in Diagnosis

• Failure to measure CRP with selenium levels can lead to misinterpretation of selenium status 5, 1
• Not considering geographical variations in selenium reference ranges 1, 8
• Overlooking selenium supplementation in patients on long-term nutritional support 1
• Mistaking symptoms for other conditions (e.g., zinc deficiency, which has similar skin manifestations) 6
• Failing to recognize that only a minority of selenium-deficient patients develop muscle disorders 2

Selenium deficiency should be suspected in any patient with unexplained muscle weakness, cardiomyopathy, skin/hair changes, or macrocytosis, especially if they belong to a high-risk group. Early recognition and supplementation can prevent progression to more severe manifestations.