Selenium Toxicity Treatment
The primary treatment for selenium toxicity is immediate cessation of selenium exposure combined with supportive care for symptoms, as there are no proven antidotes for acute selenium poisoning. 1, 2, 3
Immediate Management
Discontinue all selenium sources immediately upon recognition of toxicity, including dietary supplements, medications, and occupational exposures. 1, 3
Recognition of Toxicity Thresholds
- Plasma selenium levels >6-12 mmol/L indicate the threshold where toxicity symptoms typically occur, though the exact upper limit remains unclear. 4, 5
- Blood selenium concentrations >300 μg/L (normal: 123-193 μg/L) are associated with significant toxicity and potential mortality. 3
- Urinary selenium levels >170 μg/L (normal: 20-90 μg/L) correlate with severe toxicity. 3
Clinical Manifestations to Monitor
Early Symptoms (within 1 week of exposure):
- Garlic-like breath odor (due to pulmonary excretion of volatile selenium metabolites) 1, 6, 7
- Hair loss (alopecia) 1, 6
- Dystrophic fingernail changes and nail loss 4, 1
- Gastrointestinal symptoms: nausea, vomiting, diarrhea, abdominal pain 1, 3
- Memory difficulties and neurological changes 1
Severe Toxicity Signs:
- Cardiac complications (elevated CK, CK-MB, LDH) requiring cardiac monitoring 2
- Pulmonary symptoms and respiratory distress 6, 3
- Hypotension and stupor (in acute severe poisoning) 7
Supportive Care Protocol
Provide symptomatic and supportive treatment only, as no specific antidote exists. 1, 2, 3
Monitoring Requirements:
- Serial plasma selenium and CRP measurements to track resolution 4
- Cardiac enzyme monitoring (CK, CK-MB, LDH) in moderate-to-severe cases 2
- Continuous cardiac monitoring if cardiac symptoms develop 2
- Renal function assessment given selenium's renal excretion pathway 7
Specific Interventions:
- Hydration and electrolyte management for gastrointestinal losses 1
- Respiratory support if dyspnea or respiratory distress develops 6, 3
- Nutritional support during recovery phase 1
Dose-Toxicity Relationship
Ingested doses of 1-100 mg Se/kg body weight have been associated with mortality, with the mean cumulative dose in one case series being 1.3 grams over 37.5 days. 1, 3
Common Pitfalls to Avoid
- Do NOT use high-dose selenium supplementation (1000-4000 mg/day) in ICU patients, as meta-analyses show no consistent benefit and risk toxicity. 4, 5
- Do NOT overlook formulation errors in dietary supplements, which have caused the largest selenium toxicity epidemic in US history with almost 200 times the reported selenium content. 1
- Do NOT assume hospitalization is always required—most cases resolve with cessation and supportive care without hospitalization. 1
Long-term Considerations
Chronic selenium overexposure is positively associated with type 2 diabetes and high-grade prostate cancer, requiring long-term monitoring after resolution of acute toxicity. 4, 5
Recovery timeline: Symptoms typically manifest within 1 week of exposure onset, and selenium levels decline gradually after cessation, with monitoring needed for weeks to months depending on exposure duration and severity. 1