Selenium Deficiency Guideline

Introduction to Selenium Deficiency

Selenium deficiency can manifest as muscle weakness, cardiomyopathy, impaired immune function, and skin/hair changes, with severe cases potentially causing fatal heart failure, particularly in patients on long-term parenteral nutrition without selenium supplementation, as noted by Clinical Nutrition 1
Depigmentation of skin and hair, including hair color lightening and dry skin with irregularly shaped erythematous changes, can occur in selenium-deficient patients, according to Clinical Nutrition and Obesity Reviews 1, 2

Patients on long-term parenteral nutrition without selenium supplementation are at high risk of selenium deficiency, as reported by Clinical Nutrition 1
Patients after bariatric surgery, especially malabsorptive procedures, are also at risk of selenium deficiency, as noted by Obesity Reviews 2
Plasma selenium levels <0.4 μmol/L (<32 μg/L) indicate definite deficiency requiring immediate supplementation, according to Clinical Nutrition 3, 4
Reduced glutathione peroxidase activity in plasma and red blood cells is a marker of selenium deficiency, as reported by Clinical Nutrition 3, 4
Inflammation significantly affects selenium levels, so CRP must be measured simultaneously, with CRP levels of 10-40, 41-80, and >80 mg/L reducing plasma selenium by 15-25%, 35%, and 50% respectively, according to Clinical Nutrition 3, 4
Patients on prolonged enteral nutrition with products low in selenium, those with severe burns, and those on continuous renal replacement therapy are at risk of selenium deficiency due to increased losses, as noted by Clinical Nutrition 3
Individuals living in selenium-deficient geographical regions are at risk of selenium deficiency, according to 5

Selenium deficiency can cause erythrocyte macrocytosis (enlarged red blood cells) and anemia, as reported by Clinical Nutrition and Obesity Reviews 1, 2
Glossitis (inflammation of the tongue) and taste changes can also occur in selenium-deficient patients, according to Obesity Reviews 2
Poor wound healing is a potential consequence of selenium deficiency, as noted by Obesity Reviews 2
Cardiac arrhythmias, muscle weakness, and pain are common symptoms of selenium deficiency, with paresthesia occurring in severe cases, according to Clinical Nutrition 3
Increased susceptibility to viral infections and increased virulence of viral infections are associated with selenium deficiency, as reported by Clinical Nutrition 3

Early recognition and supplementation can prevent progression to more severe manifestations of selenium deficiency, as noted by Clinical Nutrition 1
Selenium should be routinely included in all parenteral nutrition formulations lasting more than two weeks, according to 5
Patients on long-term PN should have selenium levels checked regularly (at least every 3-6 months), as noted by Clinical Nutrition 3
Failure to measure CRP with selenium levels can lead to misinterpretation of selenium status, and not considering geographical variations in selenium reference ranges can lead to misdiagnosis, according to Clinical Nutrition 3, 4
Overlooking selenium supplementation in parenteral nutrition and inadequate monitoring of selenium levels in patients on long-term PN can lead to delayed diagnosis and treatment, as reported by Clinical Nutrition 3 and 5