Accidental death from acute selenium poisoning

To the Editor: I wish to address a statement made in a recent case report in the Journal entitled Accidental death from acute selenium poisoning.1 The authors claim that the death of a 75-year-old man after ingesting 10 g of sodium selenite “exposes the myth that natural therapies are inherently safe”.

The patient actually purchased sodium selenite powder and tablets. This is a restricted substance and an industrial chemical which would certainly have been labelled a poison.

It should be noted that the maximum recommended daily dose of selenium in complementary medicines in Australia is 52 μg.2 The authors of the case report do point out that the patient took more than 10 000 times the recommended dose of selenium which would be available from a medicine. (My calculations put this closer to 20 000 times.) An individual drinking more than 10 000 times even the daily recommended amount of water would probably not end up in much better shape. Is this evidence of an underlying agenda to discredit natural products?

The Complementary Healthcare Council of Australia recommends that consumers take steps to thoroughly inform themselves about products, preferably by asking their health care practitioner. We also urge them to inform their health care practitioner of which medicines, complementary or otherwise, they are taking.

The incident involving the sodium selenite is regrettable, but for the authors to link the product and this case of fatal ingestion to exposing the myth that natural therapies are safe is, at best, ridiculous, with no foundation.

They also state that adverse reactions to complementary and alternative medicines should be better publicised and more stringently reported to the Adverse Drug Reactions Advisory Committee. Adverse reactions are routinely reported and publicised for all medicines, and have been for some time, as any check of the website of the Therapeutic Goods Administration will show.3,4

I agree with the authors that the case highlights the dangers of consumers’ reliance on the Internet. Local Internet sites that advertise therapeutic goods must conform to the requirements of the Therapeutic Goods Advertising Code, as well as the Therapeutic Goods Act 1989 (Cwlth) and Regulations. However, overseas sites are not necessarily regulated or policed, and may provide inappropriate and misleading information. While our industry’s products are low risk, they should be taken, like other medicines, with due care.