Selenium toxicity - Revision history

Elcatracho: /* Disposition */

2021-03-08T21:21:31Z

Disposition

← Older revision		Revision as of 21:21, 8 March 2021
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	*Acute toxicities will likely require ICU level of care		*Acute toxicities will likely require ICU level of care
	*Chronic exposures are likely safe for discharge and outpatient follow up		*Chronic exposures are likely safe for discharge and outpatient follow up

			==See Also==
			*[[Toxicology (main)]]

	==References==		==References==

ClaireLewis at 20:26, 22 October 2019

2019-10-22T20:26:10Z

← Older revision		Revision as of 20:26, 22 October 2019
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	***Symptoms can occur within minutes and death can occur with 1-4 hours		***Symptoms can occur within minutes and death can occur with 1-4 hours
	**'''GI'''		**'''GI'''
	***Abdominal pain		***[[Abdominal pain]]
	***Diarrhea		***[[Diarrhea]]
	***Nausea and vomiting		***[[Nausea and vomiting]]
	***Caustic esophageal and gastric burns		***Caustic esophageal and gastric burns
	***Some patients have a garlic odor		***Some patients have a garlic odor
	**'''Myopathic'''		**'''Myopathic'''
	***Weakness		***[[Weakness]]
	***Hyporeflexia		***Hyporeflexia
	***Myoclonus		***Myoclonus
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	***Elevated CPK		***Elevated CPK
	***Renal insufficiency		***Renal insufficiency
	***Delirium and coma		***[[Delirium]] and [[coma]]
	**'''Circulatory symptoms'''		**'''Circulatory symptoms'''
	***Dyspnea		***[[Dyspnea]]
	***Chest pain		***[[Chest pain]]
	***Tachycardia		***[[Tachycardia]]
	***Hypotension		***[[Hypotension]]
	****Toxic cardiomyopathy		****Toxic [[cardiomyopathy]]
	***[[EKG]] abnormalities		***[[EKG]] abnormalities
	****[[ST elevation]]		****[[ST elevation]]
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	*Inhalation		*Inhalation
	**Hydrogen selenide		**Hydrogen selenide
	***Throat and eye pain		***[[sore throat\|Throat]] and [[eye pain]]
	***Rhinorrhea		***[[Rhinorrhea]]
	***Wheezing		***[[Wheezing]]
	***~~Pneumomediastium~~		***[[Pneumomediastinum]]
	***Restrictive and obstructive pulmonary disease		***Restrictive and obstructive pulmonary disease
	**Selenium dioxide and selenium oxide		**Selenium dioxide and selenium oxide
	***Forms selenius acid in presence of water in respiratory tract		***Forms selenius acid in presence of water in respiratory tract
	***Bronchospasm		***Bronchospasm
	***Hypotension		***[[Hypotension]]
	***Tachycardia		***[[Tachycardia]]
	***Tachypnea		***[[Tachypnea]]
	***Chemical pneumonitis		***Chemical [[pneumonitis]]
	***~~Fevers~~		***[[Fever]]s
	***Vomiting and diarrhea		***[[Vomiting]] and [[diarrhea]]
	*Dermal		*Dermal
	**Caustic burns		**[[Caustic burns]]
	*Ophthalmic		*Ophthalmic
	**Corneal injuries		**[[caustic eye exposure\|Corneal injuries]]
	**Lacrimation		**Lacrimation
	**Conjunctival edema		**Conjunctival edema
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	*No deaths from chronic exposures		*No deaths from chronic exposures
	*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels		*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
	*Alopecia with brittle hair		*[[Alopecia]] with brittle hair
	*Fatigue		*[[Fatigue]]
	*Nail deformities		*Nail deformities
	*Pruritic scalp rash		*[[pruritus\|Pruritic]] scalp [[rash]]
	*Blistered skin with persistent red color		*Blistered skin with persistent red color
	*Neurologic		*Neurologic
	**Hyperreflexia		**Hyperreflexia
	**Paresthesia		**[[Paresthesia]]
	**Anesthesia		**[[numbness\|Anesthesia]]
	**Hemiplegia		**[[weakness\|Hemiplegia]]

	==Differential Diagnosis==		==Differential Diagnosis==
Line 100:		Line 100:
	==Evaluation==		==Evaluation==
	*BMP		*BMP
	*LFTs		*[[LFTs]]
	*CBC		*CBC
	*CPK		*CPK
Line 109:		Line 109:
	*Urine < 0.03 mg/L (<0.38 μmol/L)		*Urine < 0.03 mg/L (<0.38 μmol/L)
	*Hair < 0.4 μg/g (0.01 μmol/L)		*Hair < 0.4 μg/g (0.01 μmol/L)

	==Management==		==Management==
			*Decontamination
			**Irrigation for dermal exposures
			**Consider activated charcoal or oral gastric lavage in cases that could produce significant toxicity
			**Selenious acid
			***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
			*Consult Toxicology or [[poison control]]
	*Supportive care		*Supportive care
	**Mainstay of treatment		**Mainstay of treatment
	**Acute toxicities usually require multi system support		**Acute toxicities usually require multi system support
	*Pain management		*[[analgesia\|Pain management]]
	**10% sodium thiosulfate solution/ointment to skin, nail, and eyes		**10% sodium thiosulfate solution/ointment to skin, nail, and eyes
	***Relief of pain by reduction of selenium dioxide to elemental selenium		***Relief of pain by reduction of selenium dioxide to elemental selenium
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	***Calcium gluconate gel		***Calcium gluconate gel
	****Same treatment as hydrofluoric acid exposures		****Same treatment as hydrofluoric acid exposures
	*Decontamination
	**Irrigation for dermal exposures
	**Consider activated charcoal or oral gastric lavage in cases that could produce significant toxicity
	**Selenious acid
	***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
	*Chelation		*Chelation
	**[[Dimercaprol]], CaNa<sub>2</sub>EDTA, or [[Succimer]] may form nephrotoxic complexes and worsen toxicity		**[[Dimercaprol]], CaNa<sub>2</sub>[[EDTA]], or [[Succimer]] may form nephrotoxic complexes and worsen toxicity

	==Disposition==		==Disposition==
	*Consult Toxicology or [[poison control]]
	*Acute toxicities will likely require ICU level of care		*Acute toxicities will likely require ICU level of care
	*Chronic exposures are likely safe for discharge and outpatient follow up		*Chronic exposures are likely safe for discharge and outpatient follow up

	==References==		==References==
	<references/>		<references/>

Rossdonaldson1: Text replacement - "Poison Control Center" to "poison control"

2018-08-13T18:01:23Z

Text replacement - "Poison Control Center" to "poison control"

← Older revision		Revision as of 18:01, 13 August 2018
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	==Disposition==		==Disposition==
	*Consult Toxicology or ~~Poison Control Center~~		*Consult Toxicology or [[poison control]]
	*Acute toxicities will likely require ICU level of care		*Acute toxicities will likely require ICU level of care
	*Chronic exposures are likely safe for discharge and outpatient follow up		*Chronic exposures are likely safe for discharge and outpatient follow up

Rossdonaldson1: /* Differential Diagnosis */

2018-08-12T22:39:59Z

Differential Diagnosis

@@ Line 96: / Line 96: @@
 ==Differential Diagnosis==
-===[[Heavy metal]] toxicity===
+{{Heavy metals list}}
-*[[Aluminum toxicity]]
 ==Evaluation==
 *BMP

Rossdonaldson1: /* Background */

2018-08-10T03:13:34Z

Background

← Older revision		Revision as of 03:13, 10 August 2018
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	*Deficiency found to be the cause of Keshan disease and Kashin-beck disease		*Deficiency found to be the cause of Keshan disease and Kashin-beck disease
	*Recommended daily dose is 5 μg/d		*Recommended daily dose is 5 μg/d
	*Uses
	**Gun bluing solution		===Uses===
	**Dietary supplement		*Gun bluing solution
	**Antidandruff shampoo		*Dietary supplement
	**Glass decolorizer and manufacturing		*Antidandruff shampoo
	**Insecticide		*Glass decolorizer and manufacturing
	**Vulcanization of rubber		*Insecticide
	**Used in copper refineries		*Vulcanization of rubber
			*Used in copper refineries

	===Toxicokinetics===		===Toxicokinetics===
	*Cofactor in glutathione peroxidase		*Cofactor in glutathione peroxidase

Rossdonaldson1: /* Clinical Features */

2018-08-10T03:13:11Z

Clinical Features

← Older revision		Revision as of 03:13, 10 August 2018
Line 22:		Line 22:

	==Clinical Features==		==Clinical Features==
	*'''Acute~~'''~~		===Acute===
	**Oral exposure		*Oral exposure
	***'''Triphasic course'''		**'''Triphasic course'''
	***Rapid and fulminant		**Rapid and fulminant
	****Symptoms can occur within minutes and death can occur with 1-4 hours		***Symptoms can occur within minutes and death can occur with 1-4 hours
	***'''GI'''		**'''GI'''
	****Abdominal pain		***Abdominal pain
	****Diarrhea		***Diarrhea
	****Nausea and vomiting		***Nausea and vomiting
	****Caustic esophageal and gastric burns		***Caustic esophageal and gastric burns
	****Some patients have a garlic odor		***Some patients have a garlic odor
	***'''Myopathic'''		**'''Myopathic'''
	****Weakness		***Weakness
	****Hyporeflexia		***Hyporeflexia
	****Myoclonus		***Myoclonus
	****Fasciculations		***Fasciculations
	****Elevated CPK		***Elevated CPK
	****Renal insufficiency		***Renal insufficiency
	****Delirium and coma		***Delirium and coma
	***'''Circulatory symptoms'''		**'''Circulatory symptoms'''
	****Dyspnea		***Dyspnea
	****Chest pain		***Chest pain
	****Tachycardia		***Tachycardia
	****Hypotension		***Hypotension
	*****Toxic cardiomyopathy		****Toxic cardiomyopathy
	****[[EKG]] abnormalities		***[[EKG]] abnormalities
	*****[[ST elevation]]		****[[ST elevation]]
	*****[[Prolonged QT]]		****[[Prolonged QT]]
	*****[[T wave inversions]]		****[[T wave inversions]]
	****[[Pulmonary edema]]		***[[Pulmonary edema]]
	****[[Ventricular dysrhythmias]]		***[[Ventricular dysrhythmias]]
	****[[Myocardial infarction]]		***[[Myocardial infarction]]
	****[[Mesenteric infarction]]		***[[Mesenteric infarction]]
	****[[Metabolic acidosis]]		***[[Metabolic acidosis]]
	**Inhalation		*Inhalation
	***Hydrogen selenide		**Hydrogen selenide
	****Throat and eye pain		***Throat and eye pain
	****Rhinorrhea		***Rhinorrhea
	****Wheezing		***Wheezing
	****Pneumomediastium		***Pneumomediastium
	****Restrictive and obstructive pulmonary disease		***Restrictive and obstructive pulmonary disease
	***Selenium dioxide and selenium oxide		**Selenium dioxide and selenium oxide
	****Forms selenius acid in presence of water in respiratory tract		***Forms selenius acid in presence of water in respiratory tract
	****Bronchospasm		***Bronchospasm
	****Hypotension		***Hypotension
	****Tachycardia		***Tachycardia
	****Tachypnea		***Tachypnea
	****Chemical pneumonitis		***Chemical pneumonitis
	****Fevers		***Fevers
	****Vomiting and diarrhea		***Vomiting and diarrhea
	**Dermal		*Dermal
	***Caustic burns		**Caustic burns
	**Ophthalmic		*Ophthalmic
	***Corneal injuries		**Corneal injuries
	***Lacrimation		**Lacrimation
	***Conjunctival edema		**Conjunctival edema
	*'''Chronic or Selenosis~~'''~~
	**No deaths from chronic exposures		===Chronic or Selenosis===
	**Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels		*No deaths from chronic exposures
	**Alopecia with brittle hair		*Seen in those taking nutritional supplements and in rural areas with farmland that has high selenium levels
	**Fatigue		*Alopecia with brittle hair
	**Nail deformities		*Fatigue
	**Pruritic scalp rash		*Nail deformities
	**Blistered skin with persistent red color		*Pruritic scalp rash
	**Neurologic		*Blistered skin with persistent red color
	***Hyperreflexia		*Neurologic
	***Paresthesia		**Hyperreflexia
	***Anesthesia		**Paresthesia
	***Hemiplegia		**Anesthesia
			**Hemiplegia

	==Differential Diagnosis==		==Differential Diagnosis==
	===[[Heavy metal]] toxicity===		===[[Heavy metal]] toxicity===

Rossdonaldson1: /* Toxicokinetics */

2018-08-10T03:08:12Z

Toxicokinetics

← Older revision		Revision as of 03:08, 10 August 2018
Line 11:		Line 11:
	**Vulcanization of rubber		**Vulcanization of rubber
	**Used in copper refineries		**Used in copper refineries
	==Toxicokinetics==		===Toxicokinetics===
	*Cofactor in glutathione peroxidase		*Cofactor in glutathione peroxidase
	*Varied GI absorption		*Varied GI absorption
Line 20:		Line 20:
	**Selenious acid		**Selenious acid
	*Limited data on toxicokinetics as it varies amongst compounds		*Limited data on toxicokinetics as it varies amongst compounds

	==Clinical Features==		==Clinical Features==
	*'''Acute'''		*'''Acute'''

Therriac at 18:40, 8 August 2018

2018-08-08T18:40:19Z

← Older revision		Revision as of 18:40, 8 August 2018
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	*EKG		*EKG
	*Thyroid function tests		*Thyroid function tests
			*Whole blood = 0.1–0.34 mg/L (1.27–4.32 μmol/L)
			*Serum = 0.04–0.6 mg/L (0.51–7.6 μmol/L)
			*Urine < 0.03 mg/L (<0.38 μmol/L)
			*Hair < 0.4 μg/g (0.01 μmol/L)
	==Management==		==Management==
	*Supportive care		*Supportive care

Therriac at 01:13, 8 August 2018

2018-08-08T01:13:00Z

← Older revision		Revision as of 01:13, 8 August 2018
Line 138:		Line 138:
	***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning		***Judicious use of NG lavage (as will cause caustic burns) based on time of ingestion, amount and concentration due to potential for serious systemic poisoning
	*Chelation		*Chelation
	**[[Dimercaprol]], [[CaNa<sub>2</sub>EDTA]], or [[Succimer]] may form nephrotoxic complexes and worsen toxicity		**[[Dimercaprol]], CaNa<sub>2</sub>EDTA, or [[Succimer]] may form nephrotoxic complexes and worsen toxicity

	==Disposition==		==Disposition==

Therriac at 01:11, 8 August 2018

2018-08-08T01:11:43Z

@@ Line 70: / Line 70: @@
 ****Chemical pneumonitis
 ****Fevers
-*****Vomiting and diarrhea
+****Vomiting and diarrhea
 **Dermal
 ***Caustic burns
@@ Line 77: / Line 77: @@
 ***Lacrimation
 ***Conjunctival edema
 ==Differential Diagnosis==
 ===[[Heavy metal]] toxicity===
@@ Line 103: / Line 116: @@
 *[[Zinc toxicity]]
 ==Evaluation==
+*BMP
 ==Management==
 ==Disposition==
 *Consult Toxicology or Poison Control Center
 ==References==
 <references/>