Chronic exposure to high doses of selenium in the first trimester of pregnancy: Case report and brief literature review

D’Oria, Luisa; Apicella, Massimo; Luca, Carmen De; Licameli, Angelo; Neri, Caterina; Pellegrino, Marcella; Simeone, Daniela; Santis, Marco De

doi:10.1002/bdr2.1148

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…In addition, studies which reported such signs and symptoms at plasma/serum selenium concentrations above 850 μg/L were also excluded, under the conservative assumption that a daily intake of 850 μg is equivalent to a plasma or serum selenium concentration of 850 μg/L (the prediction equation described in Section 3.3.2 is not applicable at these levels). As a result, eight publications on case reports or case series of chronic selenium poisoning were not further assessed (No authors listed, 1984;Sutter et al, 2008;Dosary et al, 2009;MacFarquhar et al, 2010;Aldosary et al, 2012;Morris and Crane, 2013;Razmi et al, 2017;D'Oria et al, 2018). In addition, the study by Garc ía-Esquinas et al (2021) was not considered because it only reported on 'weakness', without other signs and symptoms of selenium toxicity (Annex E).…”

Section: Additional Data Identifiedmentioning

confidence: 99%

Scientific opinion on the tolerable upper intake level for selenium

Turck¹,

Bohn²,

Castenmiller³

et al. 2023

EFS2

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Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for selenium. Systematic reviews of the literature were conducted to identify evidence regarding excess selenium intake and clinical effects and potential biomarkers of effect, risk of chronic diseases and impaired neuropsychological development in humans. Alopecia, as an early observable feature and a well‐established adverse effect of excess selenium exposure, is selected as the critical endpoint on which to base a UL for selenium. A lowest‐observed‐adverse‐effect‐level (LOAEL) of 330 μg/day is identified from a large randomised controlled trial in humans (the Selenium and Vitamin E Cancer Prevention Trial (SELECT)), to which an uncertainty factor of 1.3 is applied. A UL of 255 μg/day is established for adult men and women (including pregnant and lactating women). ULs for children are derived from the UL for adults using allometric scaling (body weight 0.75 ). Based on available intake data, adult consumers are unlikely to exceed the UL, except for regular users of food supplements containing high daily doses of selenium or regular consumers of Brazil nuts. No risk has been reported with the current levels of selenium intake in European countries from food (excluding food supplements) in toddlers and children, and selenium intake arising from the natural content of foods does not raise reasons for concern. Selenium‐containing supplements in toddlers and children should be used with caution, based on individual needs.

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Section: Additional Data Identifiedmentioning

confidence: 99%

Scientific opinion on the tolerable upper intake level for selenium

Turck¹,

Bohn²,

Castenmiller³

et al. 2023

EFS2

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“…However, humans seem to be relatively robust to acute Se intoxication, as most of the symptoms described from a daily intake of pills containing 22-32 mg of Se per serving were reversible, and luckily, no fatal course occurred [177]. Even more surprising are sporadic case reports, e.g., from a pregnant mother taking 200 mg of Se per day (i.e., 1000-fold higher than the commonly accepted maximal dosage used in clinical trials) during gestational weeks 7 to 12 [178]. The women lost hair and fingernails, as expected from severe selenosis, but surprisingly gave birth at term to a healthy child [178].…”

Section: Potential Toxicity Of Supplemental Sementioning

confidence: 99%

“…Even more surprising are sporadic case reports, e.g., from a pregnant mother taking 200 mg of Se per day (i.e., 1000-fold higher than the commonly accepted maximal dosage used in clinical trials) during gestational weeks 7 to 12 [178]. The women lost hair and fingernails, as expected from severe selenosis, but surprisingly gave birth at term to a healthy child [178]. These examples indicate that supplemental Se can be toxic and even fatal, irrespective of the underlying motivation for health-support or suicidal intention [179].…”

Section: Potential Toxicity Of Supplemental Sementioning

confidence: 99%

Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease

Schomburg

2021

IJMS

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The trace element selenium (Se) is an essential part of the human diet; moreover, increased health risks have been observed with Se deficiency. A sufficiently high Se status is a prerequisite for adequate immune response, and preventable endemic diseases are known from areas with Se deficiency. Biomarkers of Se status decline strongly in pregnancy, severe illness, or COVID-19, reaching critically low concentrations. Notably, these conditions are associated with an increased risk for autoimmune disease (AID). Positive effects on the immune system are observed with Se supplementation in pregnancy, autoimmune thyroid disease, and recovery from severe illness. However, some studies reported null results; the database is small, and randomized trials are sparse. The current need for research on the link between AID and Se deficiency is particularly obvious for rheumatoid arthritis and type 1 diabetes mellitus. Despite these gaps in knowledge, it seems timely to realize that severe Se deficiency may trigger AID in susceptible subjects. Improved dietary choices or supplemental Se are efficient ways to avoid severe Se deficiency, thereby decreasing AID risk and improving disease course. A personalized approach is needed in clinics and during therapy, while population-wide measures should be considered for areas with habitual low Se intake. Finland has been adding Se to its food chain for more than 35 years—a wise and commendable decision, according to today’s knowledge. It is unfortunate that the health risks of Se deficiency are often neglected, while possible side effects of Se supplementation are exaggerated, leading to disregard for this safe and promising preventive and adjuvant treatment options. This is especially true in the follow-up situations of pregnancy, severe illness, or COVID-19, where massive Se deficiencies have developed and are associated with AID risk, long-lasting health impairments, and slow recovery.

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“…Conversely, Se toxicity (selenosis) can occur with acute or chronic ingestion of excess Se. The most common adverse health impacts of selenosis are alopecia and nail brittleness and loss (30) , as well as gastrointestinal disturbances, skin rash, garlic breath odor, fatigue, irritability, and eventually nervous system abnormalities and paresthesia (31,32) . Mechanisms of Se toxicity remain unconfirmed but selenosis likely occurs as a result of oxidative stress generation and consequent disruptions of cellular and mitochondrial function (33,34) .…”

Section: Dietary Reference Values and Safe Upper Limitsmentioning

confidence: 99%

Emerging evidence on selenoneine and its public health relevance in coastal populations: a review and case study of dietary Se among Inuit populations in the Canadian Arctic

Little,

Achouba,

Ayotte

et al. 2024

Nutr. Res. Rev.

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Selenium is an essential mineral yet both deficiency and excess are associated with adverse health effects. Dietary intake of Se in humans varies greatly between populations due to food availability, dietary preferences, and local geological and ecosystem processes impacting Se accumulation into agricultural products and animal populations. We argue there is a need to evaluate and reconsider the relevance of public health recommendations on Se given recent evidence, including the metabolic pathways and health implications of Se. This argument is particularly pertinent for Inuit populations in Northern Canada, who often exceed dietary tolerable upper intake levels and exhibit very high whole blood Se concentrations due to their dependence on local country foods high in the newly discovered Se compound, selenoneine. Since selenoneine appears to have lower toxicity compared to other Se species and does not contribute to the circulating pools of Se for selenoprotein synthesis, we argue that total dietary Se or total Se in plasma or whole blood are poor indicators of Se adequacy for human health in these populations. Overall, this review provides an overview of the current evidence of Se speciation, deficiency, adequacy, and excess and implications for human health and dietary recommendations, with particular reference to Inuit populations in the Canadian Arctic and other coastal populations consuming marine foods.

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Chronic exposure to high doses of selenium in the first trimester of pregnancy: Case report and brief literature review

Cited by 6 publications

References 22 publications

Scientific opinion on the tolerable upper intake level for selenium

Scientific opinion on the tolerable upper intake level for selenium

Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease

Emerging evidence on selenoneine and its public health relevance in coastal populations: a review and case study of dietary Se among Inuit populations in the Canadian Arctic

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