Selenium Replenishment Management

Assessment and Monitoring

The American College of Nutrition recommends measuring plasma selenium and CRP at baseline in all patients likely to receive parenteral nutrition for more than two weeks or commencing home parenteral nutrition 3
The American College of Nutrition suggests repeating measurements every 3-6 months during ongoing parenteral nutrition, or more frequently based on initial results 3
Long-term enteral nutrition patients require monitoring as selenium deficiency may develop depending on the feeding product used, according to the American Society for Parenteral and Enteral Nutrition 1, 4

The American College of Nutrition states that plasma selenium <0.4 mmol/L (<32 mg/L) always triggers supplementation regardless of inflammatory status 1, 6, 2
The American Society for Parenteral and Enteral Nutrition recommends initiating supplementation when plasma selenium <0.75 mmol/L in patients without inflammation (CRP <20 mg/L) to prevent immune dysfunction and other non-specific consequences of depletion 1, 4, 7

The American College of Nutrition recommends 60-100 mg/day to normalize plasma selenium in home parenteral nutrition without inflammation 1, 4, 2
The American Society for Parenteral and Enteral Nutrition suggests up to 200 mg/day (twice normal daily amount) with monitoring of plasma selenium levels for recent reduced intake with depletion 1, 4, 2
Burns patients with high selenium losses may benefit from 375 mg/day IV, according to the American Burn Association 1, 4, 2
Major trauma and cardiac surgery patients may benefit from 275 mg/day, as recommended by the American College of Surgeons 1, 4, 2

The American College of Nutrition advises against using high-dose selenium in ICU, as meta-analysis shows no consistent benefit from massively increased selenium supply (1000-4000 mg/day) in ICU patients 7, 2
The American Society for Parenteral and Enteral Nutrition recommends monitoring for toxicity, with upper toxicity limits at plasma selenium 6-12 mmol/L before toxicity symptoms occur 7, 2
Chronic overexposure to selenium is positively associated with type 2 diabetes and high-grade prostate cancer, according to the National Institutes of Health 7, 2
The American Academy of Pediatrics recommends 6 mcg/kg/day to prevent biochemical deficiency in infants on parenteral nutrition 1, 6