4 CASES OF SELENIUM DEFICIENCY IN POSTOPERATIVE LONG-TERM ENTERAL NUTRITION

Because selenium is seldom added to formulations for enteral nutrition (EN), postoperative patients who are supported with EN are at risk fo r selenium deficiency. This report describes four cases of suspected s elenium deficiency in long-term EN. Two patients underwent pancreatico duodenectomy, one underwent total gastro-pancreatectomy, and one under went esophageal resection and reconstruction with jejunal autotranspla ntation. They all developed malabsorption syndrome within 2 yr after o peration. Enteral nutritional support with an elemental diet was provi ded continuously for 7-11 yr. Over the past 1-2 yr they experienced in creasing bilateral muscular pain and weakness in the legs, gait distur bance, palpitation, and shortness of breath. Investigation for possibl e trace element deficiency revealed very low levels of selenium in the blood. After 10-20 d of supplementation with daily intravenous admini stration of selenious acid 0.16 mg/d (100 mu g/d of selenium), their b lood levels of selenium rose and their symptoms resolved. They were th en continued on a maintenance regimen of oral sodium selenite 0.13 mg/ d (60 mu g/d of selenium).