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Acute Selenium Toxicity Associated With a Dietary Supplement
Jennifer K. MacFarquhar, RN, MPH;
Danielle L. Broussard, PhD, MPH;
Paul Melstrom, PhD;
Richard Hutchinson;
Amy Wolkin, MPH;
Colleen Martin, MPH;
Raymond F. Burk, MD;
John R. Dunn, DVM, PhD;
Alice L. Green, MS, DVM;
Roberta Hammond, PhD;
William Schaffner, MD;
Timothy F. Jones, MD
Arch Intern Med. 2010;170(3):256-261.
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 "Company A," 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 µg/d (recommended dietary allowance is 55 µg/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 µg/L (reference range,  125 µg/L). The mean initial urine selenium concentration of 7 patients was 166 µg/24 h (reference range, 55 µg/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.
Author Affiliations: Epidemic Intelligence Service (Ms MacFarquhar and Dr Melstrom) and National Center for Environmental Health (Mss Wolkin and Martin), Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville (Ms MacFarquhar and Drs Dunn, Green, Schaffner, and Jones); Florida Department of Health, Tallahassee (Drs Broussard and Hammond and Mr Hutchinson); Council for State and Territorial Epidemiologists, Atlanta (Dr Broussard); Georgia Division of Public Health, Atlanta (Dr Melstrom); and Departments of Preventive Medicine (Drs Schaffner and Jones), Medicine (Drs Burk and Schaffner), Pathology (Dr Burk), and Family Practice (Dr Jones), Vanderbilt University School of Medicine, Nashville.
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