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The Society for Minerals and Trace Elements
J. Trace Elements Med. BioI. Vol. 11, p. 126 ( 1997)
The Society for Minerals and Trace Elements Gesellschaft fOr Mineralstoffe und Spurenelemente e. V. (GMS) APPROVAL
DIAG:\fOSTICS OF IViPAIRME:\T OF SELE!,;lUM METABOLISM
Diagnostics of selenium metabolism impairment Plasma selenium
The selenium supply of healthy adulb varies greatly from region to region. World-\.\o ide. in young children selenium concentrations in plasma and urine are lower than in adulh. whereas in hair and liver the values are higher. Therefore. selenium findings in plasma (serum). whole blood (erythrocytes) and urine have to he compared with reference values for persons of the same age and region. Acute and chronic selenium intoxication may be detected by an increase in selenium concentration in plasma (serum). urine and whole blood (erythrocytes). The rate of increase does not depend solely on the other nutrients taken up. but also on the type of selenium compound taken up (organic or inorganic). The selenium-dependent enzymes (glutathione peroxida;,es in erythrocytes and plasma) do not increase their selenium1evels above their respective saturation indices. The selcnium concentration in blood (plasma. serum. erythrocytes) is decreased in many wasting di;,eases and during the second half of pregnancy. as compared with that of age-matched healthy controb. These decreases have no pathognomonic significance. Specific symptoms of selenium deficiency (myopathias of the heart and skeletalll1uscles) have been observed in selenium-deficient areas of China (Keshan di;,ease) and world-wide in a number of patients undergoing long-term parenteral nutrition. In these patients the transaminases and creatine kinase were elevated and occasionally a whitening of the hair and fingcr nails was observed. Furthermore. an endemic chondroosteoarthropathy (Kashin-Beck disease) is claimed to be caused by alimentary selenium deficiency. Selenium is an essential component of various glutathione peroxidases. deiodases. thioreductases and of different specific selenoprotein;,. According to current knowledge the saturation of seleniumdependent enLymes and proteins is achieved at lower concentrations than with glutathione peroxidase in plasma and erythrocytes (classic cyto,olic g). A complete saturation of the glutathione peroxidases is not necessary.
Decreased ,'. .+5 ng/ml. adults)
«
Increm,ed ( ;:: 20() ng/ml) Urinary selenium < 150 I.ug/g crea.) Odour of garlic'! Acute or chronic selenium intoxication possible Additional testing: SGOT.SGPT. prothrombin. nail and hair status
Glutathione peroxidase (plasma. erythrocytes)
;: 6S'Ir of reference value < 65 'Ie of reference value (shipping No manife,st seleniuIll deficiency of erythrocytes at -70 c C) Suspicion of selenium deficiency Control testing of SGOT. SGPT. CK. MCV Cardiologic examination If necessary. controlled supplementation with physiological dose of sodium selenite « 50]lg Se per day) ','Whole blood selenium values are 1.el-fold higher on the average than plasma selenium values. I. LOIll""c/.:
Board of the executives President: Prof. Dr. Wilhelm Frescnius Institut Fresenius. Chemische und Biologische Laboratorien GmbH, 1m Maisel 14.0-65232 Taunmstein. Germany. Vice Presidents: Prof. Dr. Peter Bratter Hahn-Meitner Institut Berlin. Abt. Spurenelemente in Gesundheit und Ernahrung. Glienicker Str. 100. 0-141 D9 Berlin. Germany. Prof. Dr. Heinz Liesen Sportmedizinisches Institut der Universitat Paderborn. Warhurger Str. 100. D-3.109X. Germany. General Secretary: Prof. Dr. Dr. Klaus Diirner SWdtisches Krankenhaus Kiel. Zentrailaboratorium. Chemnitzstr. 33. 0-24116 Kicl. Germany. Tel. ++49 (0431) 1697 347. Fax. ++49 (0431) 1697409 Chairman of the Scientific Committee: Prof. Dr. JUrgen D. Kruse-Jan'es Katharinenhospital. Ar/tlicher Direktor. Kriegsbergstr. 60. 0-70174 Stuttgart. Germany.
The Society for Minerals and Trace Elements Gesellschaft fOr Mineralstoffe und Spurenelemente e. V. (GMS) APPROVAL
DIAG:\fOSTICS OF IViPAIRME:\T OF SELE!,;lUM METABOLISM
Diagnostics of selenium metabolism impairment Plasma selenium
The selenium supply of healthy adulb varies greatly from region to region. World-\.\o ide. in young children selenium concentrations in plasma and urine are lower than in adulh. whereas in hair and liver the values are higher. Therefore. selenium findings in plasma (serum). whole blood (erythrocytes) and urine have to he compared with reference values for persons of the same age and region. Acute and chronic selenium intoxication may be detected by an increase in selenium concentration in plasma (serum). urine and whole blood (erythrocytes). The rate of increase does not depend solely on the other nutrients taken up. but also on the type of selenium compound taken up (organic or inorganic). The selenium-dependent enzymes (glutathione peroxida;,es in erythrocytes and plasma) do not increase their selenium1evels above their respective saturation indices. The selcnium concentration in blood (plasma. serum. erythrocytes) is decreased in many wasting di;,eases and during the second half of pregnancy. as compared with that of age-matched healthy controb. These decreases have no pathognomonic significance. Specific symptoms of selenium deficiency (myopathias of the heart and skeletalll1uscles) have been observed in selenium-deficient areas of China (Keshan di;,ease) and world-wide in a number of patients undergoing long-term parenteral nutrition. In these patients the transaminases and creatine kinase were elevated and occasionally a whitening of the hair and fingcr nails was observed. Furthermore. an endemic chondroosteoarthropathy (Kashin-Beck disease) is claimed to be caused by alimentary selenium deficiency. Selenium is an essential component of various glutathione peroxidases. deiodases. thioreductases and of different specific selenoprotein;,. According to current knowledge the saturation of seleniumdependent enLymes and proteins is achieved at lower concentrations than with glutathione peroxidase in plasma and erythrocytes (classic cyto,olic g). A complete saturation of the glutathione peroxidases is not necessary.
Decreased ,'. .+5 ng/ml. adults)
«
Increm,ed ( ;:: 20() ng/ml) Urinary selenium < 150 I.ug/g crea.) Odour of garlic'! Acute or chronic selenium intoxication possible Additional testing: SGOT.SGPT. prothrombin. nail and hair status
Glutathione peroxidase (plasma. erythrocytes)
;: 6S'Ir of reference value < 65 'Ie of reference value (shipping No manife,st seleniuIll deficiency of erythrocytes at -70 c C) Suspicion of selenium deficiency Control testing of SGOT. SGPT. CK. MCV Cardiologic examination If necessary. controlled supplementation with physiological dose of sodium selenite « 50]lg Se per day) ','Whole blood selenium values are 1.el-fold higher on the average than plasma selenium values. I. LOIll""c/.:
Board of the executives President: Prof. Dr. Wilhelm Frescnius Institut Fresenius. Chemische und Biologische Laboratorien GmbH, 1m Maisel 14.0-65232 Taunmstein. Germany. Vice Presidents: Prof. Dr. Peter Bratter Hahn-Meitner Institut Berlin. Abt. Spurenelemente in Gesundheit und Ernahrung. Glienicker Str. 100. 0-141 D9 Berlin. Germany. Prof. Dr. Heinz Liesen Sportmedizinisches Institut der Universitat Paderborn. Warhurger Str. 100. D-3.109X. Germany. General Secretary: Prof. Dr. Dr. Klaus Diirner SWdtisches Krankenhaus Kiel. Zentrailaboratorium. Chemnitzstr. 33. 0-24116 Kicl. Germany. Tel. ++49 (0431) 1697 347. Fax. ++49 (0431) 1697409 Chairman of the Scientific Committee: Prof. Dr. JUrgen D. Kruse-Jan'es Katharinenhospital. Ar/tlicher Direktor. Kriegsbergstr. 60. 0-70174 Stuttgart. Germany.