@article{ref1,
title="Acute selenium toxicity associated with a dietary supplement",
journal="Archives of internal medicine",
year="2010",
author="Macfarquhar, Jennifer K. and Broussard, Danielle L. and Melstrom, Paul and Hutchinson, Richard and Wolkin, Amy and Martin, Colleen and Burk, Raymond F. and Dunn, John R. and Green, Alice L. and Hammond, Roberta and Schaffner, William and Jones, Timothy F.",
volume="170",
number="3",
pages="256-261",
abstract="BACKGROUND: Selenium is an element necessary for normal cellular function, but it can have toxic effects at high doses. We investigated an outbreak of acute selenium poisoning. METHODS: A case was defined as the onset of symptoms of selenium toxicity in a person within 2 weeks after ingesting a dietary supplement manufactured by &quot;Company A,&quot; purchased after January 1, 2008. We conducted case finding, administered initial and 90-day follow-up questionnaires to affected persons, and obtained laboratory data where available. RESULTS: The source of the outbreak was identified as a liquid dietary supplement that contained 200 times the labeled concentration of selenium. Of 201 cases identified in 10 states, 1 person was hospitalized. The median estimated dose of selenium consumed was 41 749 mug/d (recommended dietary allowance is 55 mug/d). Frequently reported symptoms included diarrhea (78%), fatigue (75%), hair loss (72%), joint pain (70%), nail discoloration or brittleness (61%), and nausea (58%). Symptoms persisting 90 days or longer included fingernail discoloration and loss (52%), fatigue (35%), and hair loss (29%). The mean initial serum selenium concentration of 8 patients was 751 mug/L (reference range, </=125 mug/L). The mean initial urine selenium concentration of 7 patients was 166 mug/24 h (reference range, </=55 mug/24 h). CONCLUSIONS: Toxic concentrations of selenium in a liquid dietary supplement resulted in a widespread outbreak. Had the manufacturers been held to standards used in the pharmaceutical industry, it may have been prevented.<p /> <p>Language: en</p>",
language="en",
issn="0003-9926",
doi="10.1001/archinternmed.2009.495",
url="http://dx.doi.org/10.1001/archinternmed.2009.495"
}