Selenium supplementation in the critically ill: posology and pharmacokinetics

To analyze current evidence for the posology and pharmacokinetics of selenium supplementation in the critically ill.Antioxidants and especially high-dose parenteral selenium may be associated with a significant reduction in mortality among critically ill patients with systemic inflammatory response syndrome (SIRS). Selenium seems to be a cornerstone of the antioxidant defense in SIRS patients. In the past few years, several clinical studies have evaluated the effect of selenium (as sodium selenite) in monotherapy or as part of a multimicronutrient approach, on relevant end points for the critically ill. However, the results from these studies have sometimes been contradictory. We now have a better understanding of the pharmacokinetics of the transient prooxidant effect of an intravenous (i.v.) bolus followed by the antioxidant effect of continuous infusion, which seems efficacious and well tolerated. Clinical confirmation of the potentially advantageous synergism between selenium and glutamine may soon be forthcoming, but the most appropriate and the optimum time of supplementation remains undetermined.This review summarizes current knowledge on selenium supplementation in the critically ill. High-dose i.v. selenite as a bolus injection plus continuous infusion appears well tolerated and optimizes selenium plasma levels and antioxidant selenoenzymes activities. Additional investigations into the posology and pharmacokinetic profile of selenium are still required. Further studies should aim to demonstrate a definitive benefit of i.v. selenite, alone or in combination, on antioxidant capacity and mortality in the critically ill.