Letters
Metabolic diseases
Volume 186 - Issue 9

Accidental death from acute selenium poisoning

Author:  Ian Brighthope

Med J Aust 2007; 186 (9): 487-488. || doi: 10.5694/j.1326-5377.2007.tb01016.x
Published online: 7 May 2007
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To the Editor: It is of great concern to me that the recent case report Accidental death from acute selenium poisoning by See and colleagues1 inappropriately cast doubts on the safety of complementary and alternative medicines (CAM). This incident should be placed in its correct context.

The guidelines are clear for listed complementary medicines (ie, compounds or formulas registered and approved by the Australian Register of Therapeutic Goods for distribution in Australia).2

As a trace element, selenium is required in microgram amounts. The Therapeutic Goods Administration stringently regulates its use in nutritional supplements in Australia, with an allowed limit of 26 μg per daily dose (as selenomethionine) in unrestricted products, and 50 μg per daily dose (as selenite) in restricted, pharmacy-only supplements.

This is considerably less than the “no observed adverse effects level” for selenium, which is as high as 400 μg per day,3 as noted by See and colleagues. Furthermore, even at these low doses, CAM products that contain selenium must carry substantial “red flag” label warnings. Bulk sodium selenite powder — the form which led to this fatality — is definitely not dispensed as a complementary medicine.

Nevertheless, the authors of the case report conclude that “adverse outcomes of complementary and alternative medicines should be better publicised and more stringently reported to the Adverse Drug Reactions Advisory Committee (ADRAC)”.

While this may be a commendable recommendation, it is inappropriate and incongruous with the findings presented in this case report. Furthermore, the sodium selenite used by nutritional doctors is administered as a liquid at a dose of 50 μg per drop, and is a restricted S4 prescription-only product.

To achieve a dose of 10 g of sodium selenite, as taken by the reported patient, would require ingestion of 115 bottles of the registered S4 supplement or, even less plausibly, 400 000 doses of a listed CAM supplement. Neither of these preparations was implicated in the reported case.

So why then are the authors of this case report asking for increased vigilance for complementary medicines? It is surely the interchange between the pharmacist and the customer that lies at the heart of this matter. Had a listed selenium product been dispensed, this poisoning would not have occurred.

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