Selenium supplementation in critically ill patients can too much of a good thing be a bad thing 英文参考文献.docVIP

Available online /content/11/4/153 Commentary Selenium supplementation in critically ill patients: can too much of a good thing be a bad thing? Daren K Heyland Clinical Evaluation Research Unit, Angada 4 Kingston General Hospital, Kingston, ON K7L 2V7, Canada Corresponding author: Daren K Heyland, dkh2@post.queensu.ca Published: 7 August 2007 Critical Care 2007, 11:153 (doi:10.1186/cc5975) This article is online at /content/11/4/153 ? 2007 BioMed Central Ltd See related research by Forceville et al., /content/11/4/R73 Abstract depletion of intracellular glutathione, excessive oxidative stress, and cell death [5]. The toxicity of selenium is clearly dose dependent and varies depending on the type of selenium compound administered [5]. A recent study by Forceville and colleagues evaluated the effect of high-dose selenium administration as a treatment for septic shock. The study was negative and conflicts with existing clinical data regarding selenium administration in critically ill patients. Perhaps the key to understanding the differences between these discrepant observations lies in considering the dose and timing of selenium Forceville and colleagues attempt to take advantage of this dual effect of selenium in treating septic shock by administration. administering a high, pro-oxidant dose (4,000μg) on study day 1, followed by an antioxidant dose of 1,000μg/day for an additional 9 days. In a randomized trial of 60 patients with severe sepsis, they were unable to detect any treatment effect of this selenium administration strategy. Why do their findings contradict those of the recent meta-analysis [4], which suggests a large decrease in mortality? Selenium is an essential nutrient for all mammalian species, and in this issue of Critical Care Forceville and colleagues [1] evaluated the effect of high-dose selenium administration