Epidemiologic Notes and Reports Selenium Intoxication --
New York
On December 27, 1983, a 57-year-old female in New York began
taking a daily selenium supplement distributed by Brite Years,
Inc.,
of Tempe, Arizona. The label on the 90-tablet bottle recommended
taking one of the 150-mcg tablets daily. She took the prescribed
number in addition to her usual daily vitamins, which included:
vitamin C (1,000 mg, plus bioflavinoids, thrice daily); vitamin A
(10,000 units once daily); vitamin D (400 units once daily);
vitamin E
(400 units once daily); B complex (once daily); and a high-potency
mineral supplement labeled as containing all 72 trace elements in
undefined quantities, as well as calcium, magnesium, phosphate,
potasium, zinc, iron, manganese, and iodine. She consumed at least
one vitamin C tablet (1,000 mg) simultaneously with the selenium
supplement.
Approximately 11 days after starting the selenium supplement,
the
patient noted marked hair loss limited to her scalp, which
progressed
over a 2-month period to almost total alopecia. Two weeks later,
she
noted white horizontal streaking on the fingernail of her left
fifth
digit, tenderness and swelling on the fingertip, and purulent
discharge from the fingernail bed. This progressed over a 3-week
period to involve all fingernails. The patient subsequently lost
the
entire fingernail of her left fifth digit. In addition, she
experienced periodic episodes of nausea and vomiting, a sour-milk
breath odor, and increasing fatigue. In January, she consulted a
dermatologist for her hair loss and nail changes and was treated
with
oral erythromycin for paronychia. Her alopecia was attributed to
emotional stress following the death of her husband a year earlier.
On March 11, 1984, she heard on the radio that the selenium
tablets distributed by Brite Years, Inc., were being recalled
because
of superpotency. She stopped taking the tablets and consulted her
internist. She had consumed 77 of the 90 tablets. A serum
selenium
level from March 15 was reported as 528 ng/ml, approximately four
times the normal levels for the U.S. population (1).
The distributor voluntarily recalled the product when analysis
of
the selenium tablets from one lot revealed a selenium level of 27.3
mg
per tablet (182 times higher than labeled). The implicated tablets
were reportedly manufactured by Superior Health Vitamin and Health
Foods in Deer Park, New York, for the distributor. These tablets
were
part of approximately 250 bottles distributed to 39 accounts in 15
states (Alaska, Alabama, Arizona, Arkansas, California, Iowa,
Missouri, Montana, New York, Ohio, Oregon, Pennsylvania, Texas,
Utah,
and Virginia) from four distribution lots (codes 012163, 016213,
301216, and 012161). Subsequent analyses of tablets from all four
implicated distribution lots have contained 25 mg of sodium
selenite
and 4 mg-5 mg total of elemental and/or organic selenium. Analysis
of
tablets taken from the symptomatic woman in New York found 31 mg of
total selenium per tablet.
Reported by R Jensen, DO, W Closson, PhD, Brunswick Hospital,
Amityville, R Rothenberg, MD, State Epidemiologist, New York State
Dept of Health; Emergency and Epidemiological Operations Br,
Brooklyn
District Office, U.S. Food and Drug Administration; Cancer
Prevention
Studies Br, Div of Cancer Prevention and Control, National Cancer
Institute; Office of the Director, Epidemiology Program Office,
CDC.
Editorial Note
Editorial Note: Selenium is widely, though irregularly,
distributed
in soil, forages, and grains and has many commercial uses. Human
intake of selenium comes mainly from cereal, fish, and meat in the
diet, and, in residents of one city studied, averaged 81 mcg per
day
(2). While there is no established recommended daily allowance,
the
proposed adequate and safe intake of selenium in adults is 50
mcg-200
mcg daily (3). Until lately, there were no well-documented cases
of
human selenium toxicity. A recent study reported a number of
villages
in the People's Republic of China, where high percentages of
individuals had nail and hair loss, dermatitis, nausea, garlic odor
on
their breath, fatigue, irritability, and hyperreflexia (4).
Individual daily dietary selenium intake in this area ranged from
3.20
mg to 6.69 mg (average 4.99 mg), and whole blood levels of selenium
ranged from 1,300 ng/ml to 7,500 ng/ml (average 3,200 ng/ml).*
The signs and symptoms exhibited by the New York woman were
almost
certainly due to selenium intoxication. The estimated cumulative
dose
of selenium she ingested over the 77 days was 2,387 mg. Her
toxicity
was probably minimized by the simultaneous ingestion of large doses
of
vitamin C. Vitamin C reduces selenite to elemental selenium that
is
poorly absorbed.
This incident demonstrates that excessive doses of trace
elements
can have toxic effects. Implementation of improved quality-control
measures in the manufacture of these food supplements could help
alleviate problems of this nature in the future. With the general
increase in use of vitamin and mineral supplements in this country,
the public and the medical community should be aware of the
potential
for toxicity.
References
Levander OA. Unpublished data.
Welsh SO, Holden JM, Wolf WR, Levander OA. Selenium in
self-selected diets of Maryland residents. J Am Diet Assoc
1981;79:277-85.
Committee on Dietary Allowances, Food and Nutrition Board.
Recommended dietary allowances. Ninth revised edition, 1980.
National Academy of Sciences, Washington, D.C., p. 162
Yang G, Wang S, Zhou R, Sun S. Endemic selenium intoxication
of
humans in China. Am J Clin Nutrition 1983;37:872-81.
*Whole blood selenium measurements are approximately 30% higher
than
serum selenium.
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