Selenium Deficiency in a Patient with Crohn's Disease Receiving Long-term Total Parenteral Nutrition.

Abstract

Wereport a case of selenium deficiency in a patient with Crohn's disease on long-term total parenteral nutrition (TPN). She manifested lassitude of the legs, discoloration of the nail beds, and macrocytosis. Since her plasma selenium level was found to be below the measurable level, we diagnosed this case as selenium deficiency. After intravenous administration of sodium selenite, her symptoms were reversed. Careful attention should be paid to selenium deficiency when a patient receives longterm TPN;supplementary administration of selenium via TPNmaybe required because selenium is often not routinely added to TPN formulations. (Internal Medicine 42: 154-157, 2003)

Management and Complications of Short Bowel Syndrome: an Updated Review

“…There are no adequate measures of Zn status, although serum concentrations may be a helpful, but not definitive guide to therapy. Selenium (Se) deficiency is uncommon, but may occur in the setting of significant diarrhea and especially if omitted from the PN formulation [56]. Copper (Cu) deficiency may occur in the absence of parenterally administered copper, although care must be given to avoid toxicity.…”

Nails in nutritional deficiencies

“…[2] Patients on prolonged total parenteral nutrition (TPN) tend to become selenium deficient; cases have been reported where the fingernails turned white in association with low serum and urinary selenium levels and the nail changes resolved dramatically after selenium therapy was instituted. [19,20] Clubbing of nails is associated with the cretinism caused by iodine deficiency. [2] NAIL CHANGES IN VITAMIN DEFICIENCIES Fat-soluble vitamins Hapalonychia (soft nails) has been associated with deficiencies of vitamins A and D among other causes.…”

Zur klinischen Bedeutung von Selen: Ein systematischer Review

“…Selen-Mangelerscheinungen sind bisher bei schweren chronischen Krankheiten beschrieben worden, die auch den Magen-Darm-Trakt betreffen; zum Beispiel langdauernde parenterale Ernährung (etwa bei Morbus Crohn [13], "Short Bowel Syndrom" nach operativer Entfernung eines grossen Teils des Darms [14,15], chronischer Pankreatitis [16], Phenylketonurie [17] oder bei zystischer Fibrose [18].…”