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Selenium supplementation in the critically ill.
Nutr Clin Pract 2012; 27(1):21-33NC

Abstract

Selenium (Se) is an essential trace element with antioxidant, immunological, and anti-inflammatory properties, which are attributed to its presence in selenoproteins, as the 21st amino acid selenocysteine. These selenoenzymes are involved in redox signaling, antioxidant defense, thyroid hormone metabolism, and immune responses. Dietary intakes differ considerably between geographical regions, due to variability of the Se food content, leading to differences in dietary reference intakes and toxicity cautions. Critical illness with systemic inflammatory response syndrome (SIRS) is characterized by Se depletion with high morbidity and mortality. Se status correlates well with clinical outcome in SIRS and may be useful as an early predictor of survival. Several investigators have evaluated the benefits of Se supplementation for the critically ill, either as monotherapy or in an antioxidant micronutrient combination. Pharmaconutrition, with high-dose Se (from 500-1600 µg/d) involving an initial loading bolus, followed by continuous infusion, appears to be safe and efficacious, with evidence that it can improve clinical outcome by reducing illness severity, infectious complications, and decreasing mortality in the intensive care unit (ICU). We now have a clearer understanding of the pharmacokinetics of the initial and transient pro-oxidant effect of an intravenous bolus of selenite and the antioxidant effect of continuous infusion. Better biomarkers to ascertain optimum Se requirements for individual patients are now needed, and clinical practice guidelines need improvement. Nevertheless, sufficient evidence is available to consider initiating high-dose intravenous Se therapy routinely in critically ill SIRS patients, immediately on admission to the ICU.

Authors+Show Affiliations

Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. g.hardy@auckland.ac.nzNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22307489

Citation

Hardy, Gil, et al. "Selenium Supplementation in the Critically Ill." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 27, no. 1, 2012, pp. 21-33.
Hardy G, Hardy I, Manzanares W. Selenium supplementation in the critically ill. Nutr Clin Pract. 2012;27(1):21-33.
Hardy, G., Hardy, I., & Manzanares, W. (2012). Selenium supplementation in the critically ill. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 27(1), pp. 21-33. doi:10.1177/0884533611434116.
Hardy G, Hardy I, Manzanares W. Selenium Supplementation in the Critically Ill. Nutr Clin Pract. 2012;27(1):21-33. PubMed PMID: 22307489.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selenium supplementation in the critically ill. AU - Hardy,Gil, AU - Hardy,Ines, AU - Manzanares,William, PY - 2012/2/7/entrez PY - 2012/2/7/pubmed PY - 2012/7/28/medline SP - 21 EP - 33 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 27 IS - 1 N2 - Selenium (Se) is an essential trace element with antioxidant, immunological, and anti-inflammatory properties, which are attributed to its presence in selenoproteins, as the 21st amino acid selenocysteine. These selenoenzymes are involved in redox signaling, antioxidant defense, thyroid hormone metabolism, and immune responses. Dietary intakes differ considerably between geographical regions, due to variability of the Se food content, leading to differences in dietary reference intakes and toxicity cautions. Critical illness with systemic inflammatory response syndrome (SIRS) is characterized by Se depletion with high morbidity and mortality. Se status correlates well with clinical outcome in SIRS and may be useful as an early predictor of survival. Several investigators have evaluated the benefits of Se supplementation for the critically ill, either as monotherapy or in an antioxidant micronutrient combination. Pharmaconutrition, with high-dose Se (from 500-1600 µg/d) involving an initial loading bolus, followed by continuous infusion, appears to be safe and efficacious, with evidence that it can improve clinical outcome by reducing illness severity, infectious complications, and decreasing mortality in the intensive care unit (ICU). We now have a clearer understanding of the pharmacokinetics of the initial and transient pro-oxidant effect of an intravenous bolus of selenite and the antioxidant effect of continuous infusion. Better biomarkers to ascertain optimum Se requirements for individual patients are now needed, and clinical practice guidelines need improvement. Nevertheless, sufficient evidence is available to consider initiating high-dose intravenous Se therapy routinely in critically ill SIRS patients, immediately on admission to the ICU. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/22307489/Selenium_supplementation_in_the_critically_ill_ L2 - https://doi.org/10.1177/0884533611434116 DB - PRIME DP - Unbound Medicine ER -