Sodium selenite therapy in the critically ill patients: supplementation or pharmacological intervention?

Abstract

Sepsis-related organ dysfunction remains a major cause of death in the intensive care unit (ICU). So far, different adjunct therapies including antioxidant micronutrients have been developed to improve survival in septic patients.According to current evidence, selenium therapy should be considered as the cornerstone antioxidant strategy and not only as an antioxidant supplementation in ICU patients. The selenocompounds including selenious acid (H₂SeO₃) and sodium selenite (Na₂SeO₃) provided as pentahydrate sodium selenite (5H₂O-Na₂SeO₃) should be considered as drugs with oxidant and cytotoxic effects when a loading dose is administered as intravenous bolus. Teratogenic and carcinogenic risks should also be taken into consideration. Animal studies are still required to define Na₂SeO₃ mechanisms of action and toxicity. A better understanding of its pharmacokinetic profile, duration of therapy, and long-term toxicity data is required. Additionally, the effect of selenium therapy in sepsis should be assessed in large, well-designed phase III clinical trials. Our purpose is to review selenium therapy in ICU adult patients, investigating whether its effects are related to a simple supplementation or a pharmacological intervention.