THE NECESSITY OF SELENIUM SUBSTITUTION IN TOTAL PARENTERAL-NUTRITION AND ARTIFICIAL ALIMENTATION

For the trace element selenium, in contrast to zinc, iron, copper, chr omium, manganese and iodine, there is still no clear official recommen dation with regard to routine substitution in artificial nutrition. An overview of the manifestations of selenium deficiency in humans durin g the period 1979 - 1995 shows that nutritive deficiencies are exclusi vely TPN-induced or the result of severe malnutrition. The pathology o f TPN-induced selenium deficiency and the analytic assessment of selen ium status are described. Patients undergoing long-term parenteral nut rition or suffering from an increased loss of intestinal secretions ha ve to be characterized as being especially at risk for clinical seleni um deficiency. The relationship of the serum selenium kinetics in pedi atric and adult patients to the depletion of body compartments during the course of short-term and prolonged TPN is discussed. Because of th e importance of the selenoproteins, the regularly occurring depletion during selenium-free TPN and the borderline supply of selenium in Germ any the routine substitution of selenium in TPN is strongly recommende d. The pharmaceutical industry should be encouraged to develop a trace element solution that includes selenium, so that the nutritive requir ement of patients on TPN can be satisfied. Adequate intravenous dosage recommendations are based on maintenance of glutathione peroxidase ho meostasis. The routine supplementation dosage may not meet the seleniu m requirements of intensive care patients under conditions of increase d metabolic demands on their anti-oxidative system.