Selenium Supplementation Guidelines

Introduction to Selenium Supplementation

The American Clinical Nutrition society recommends a daily selenium intake of 60-100 µg for patients without inflammation to normalize plasma selenium levels during home parenteral nutrition 1, 2
The European Clinical Nutrition society suggests that patients with proven deficiency (recently reduced intake) may require up to 200 µg/day with monitoring of plasma selenium levels, and oral administration is possible if the gastrointestinal tract is available 1, 2

The American Clinical Nutrition society states that plasma selenium levels <0.4 mmol/L (<32 mg/L) always require supplementation, regardless of inflammation status 3, 2
The European Clinical Nutrition society recommends supplementation for patients without inflammation when plasma selenium levels are <0.75 mmol/L to prevent immune function disorders 4, 2

The American Clinical Nutrition society recommends 375 µg/day intravenously for burn patients (faster healing, fewer infections) 1, 2
The European Clinical Nutrition society suggests 275 µg/day for severe trauma and heart surgery patients 1, 2
The American Clinical Nutrition society states that patients with renal replacement therapy require increased amounts due to increased losses and oxidative stress 1
The European Clinical Nutrition society recommends 100 µg/day for 2 weeks to quickly correct acute deficiency (plasma selenium <0.4 mmol/L), with the intravenous route preferred 1

The American Clinical Nutrition society advises against high-dose supplementation in intensive care units: meta-analyses show no consistent benefit of massively increased selenium intake (1000-4000 µg/day) in intensive care patients - this is explicitly not recommended 1, 2
The European Clinical Nutrition society warns of the risk of toxicity, with upper toxicity limits at plasma selenium levels of 6-12 mmol/L 1, 2
The American Clinical Nutrition society notes that chronic overexposure should be avoided due to positive associations with type 2 diabetes and high-grade prostate cancer in long-term over-supplementation 3, 2
The European Clinical Nutrition society emphasizes the importance of considering inflammation, as plasma selenium levels fall by 15-25% with CRP 10-40 mg/L, by 35% with CRP 41-80 mg/L, and by 50% with CRP >80 mg/L - simultaneous CRP measurement is therefore obligatory for correct interpretation 4, 3

The American Clinical Nutrition society recommends baseline measurement of plasma selenium and CRP in all patients expected to receive parenteral nutrition for >2 weeks 2
The European Clinical Nutrition society suggests follow-up controls every 3-6 months during ongoing parenteral nutrition, more frequently with initially low values 2
The American Clinical Nutrition society states that regular monitoring is required for long-term enteral nutrition, as the selenium content of products varies 4, 2

The American Clinical Nutrition society prefers the oral route, starting with 100 µg/day, if there is good enteral absorption and no contraindications 1
The European Clinical Nutrition society recommends the intravenous route for plasma selenium <0.4 mmol/L to quickly correct deficiency, up to 400 µg/day for at least 7-10 days, then control 1