Selenium deficiency in long-term total parenteral nutrition

Impact of nationwide essential trace element shortages: A before-after, single-center analysis of hospitalized adults receiving home parenteral nutrition therapy

BACKGROUND

Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages.

METHODS

We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods.

RESULTS

Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%).

CONCLUSION

ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.

Effect of administration route and dose on metabolism of nine bioselenocompounds

The nutritional availability of selenium (Se) is highly dependent on its chemical form because chemical form affects absorption, distribution, metabolism, and excretion. We evaluated the effects of administration route and dose on the bioavailability of nine Se compounds found in biota, the so-called bioselenocompounds, such as selenite, selenate, selenocyanate (SeCN), Se-methylselenocysteine (MeSeCys), selenomethionine (SeMet), selenohomolanthionine (SeHLan), selenocystine (SeCys2), 1β-methylseleno-N-acetyl-d-galactosamine (SeSug1), and trimethylselenonium ion (TMSe). We determined the bioavailability of bioselenocompounds recovered as urinary selenometabolites and serum selenoproteins from urine and serum of Se-deficient rats after the administration of bioselenocompounds by speciation analysis. Urinary Se was more easily recovered than serum selenoproteins, suggesting that the speciation of urinary Se is a better tool to indicate Se status in the body. The intravenous administration of bioselenocompounds showed different Se bioavailability from the oral administration. Intestinal microflora might be involved in the bioavailability of some bioselenocompounds, such as SeCN, MeSeCys, and SeSug1.

Muehrcke's lines (Leukonychia striata) due to transretinoic acid therapy for acute promyelocytic leukemia

Transverse leukonychia (Leukonychia striata or Muehrcke's lines) has been described with the use of several drugs in oncology, mainly chemotherapeutic agents. This condition is thought to represent an abnormality of the vascular nail bed. As the diagnosis is clinical and the condition is self-limited, referral to other specialists is usually not required. We report the first case of transverse leukonychia related to the use of transretinoic acid for acute promyelocytic leukemia. Physician awareness of transverse leukonychia is important in order to reassure the patients and avoid unnecessary (and often not inexpensive) diagnostic work-up.

Clinical features of selenium deficiency in infants receiving long-term nutritional support

OBJECTIVE

Selenium deficiency is a known complication in patients requiring long-term nutritional support; however, the clinical features of selenium deficiency in infants have not been completely described. We describe the clinical features of selenium deficiency in infants.

METHODS

Six infants with selenium deficiency were studied retrospectively, with a focus on the period of nutritional support, the clinical symptoms, and the chronologic changes in serum selenium concentrations before and after the administration of selenite.

RESULTS

The onset of selenium deficiency in five patients occurred at <6 mo of age; selenium deficiency occurred in one patient 14 mo after birth. One patient received parenteral nutrition for 15 mo after birth; the other five patients primarily received an elemental diet for 2-6 mo. In all patients, growth retardation and alopecia with pseudoalbinism were the characteristic symptoms of selenium deficiency. At the time of diagnosis, the serum selenium level in four patients was <2.0 microg/dL and serum selenium levels in two patients were 3.2 and 3.3 microg/dL, respectively. The resolution of hair symptoms corresponded to the level of serum selenium after 1-2 mo and a rapid improvement in growth occurred in all patients after the administration of selenite.

CONCLUSION

The early clinical symptoms of selenium deficiency in infants include growth retardation and alopecia with pseudoalbinism, which are reversible if the patients are treated with adequate amounts of selenite. Clinicians who manage infants receiving long-term nutritional support, including an elemental diet, should be aware of the symptoms associated with selenium deficiency.