Graham Jones wrote
> I am writing for assistance with a serendipidous finding of elevated
> plasma selenium. An otherwise well man with psoriasis was identified as
> having a repeatable plasma selenium level of 3.2 umol/L (rr 0.9-1.4
> umol/L) by ICP-MS. He showed no signs of clinical toxicity (no hair or
> nail changes or neuropathy). His only unusual substance exposures which I
> do not know the content of are a psoriasis shampoo ("Fungitar?"), 3 cigars
> per day, and seasonings for Thai food. Nearly all his food is bought at a
> suburban supermarket, he does not take regular . My only similar cases
> have had readily identifiable sources (ie self-medication with selenium to
> prevent cancer).
>
> Do any of these sources raise suspicions?
>
> Many thanks,
>
> Graham Jones
> Staff Specialist in Chemical Pathology
> St Vincent's Hospital, Sydney
>
Probably the shampoo - but it will tell you on the label whether or
not it contains selenium, which is added to some shampoos. I
don't think that particular brand is sold in the UK. There is one well
known selenium-containing shampoo here (whose name I will not
mention on the mailbase since the manufacturers are emphatic
that it cannot be a cause of selenium toxicity). I've come across
one case where the patient had been using this shampoo every
day for some years and also sitting in the hot bath (as one does -
watching the rubber ducky swimming around) for a while after
rinsing his hair in the water. The selenium was absorbed through
his skin via the bath water in large amounts and he was
subsequently found to have a plasma selenium similar to that
which you report - together with a hair selenium several hundred
times greater than the top of the reference interval.
This doesn't mean that these shampoos are a cause of selenium
toxicity if used in a reasonable manner (on the hair and scalp only,
rinsed out after a short while).
Best wishes,
Nick Miller,
London
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