Drug Shortages and Selenium Deficiency

If you participate in the care of patients who are dependent on parenteral nutrition, then you are familiar with frequent component drug shortages.  Generally, attempts to manage these shortages involve rationing and targeting those with the greatest need.  In one institution, this was not effective in preventing biochemical deficiency of selenium (JPEN 2013; DOI 10.1177/0148607113486005).  Thanks to Kipp Ellsworth for this reference.

The authors describe five pediatric patients who were completely dependent on parenteral nutrition due to intestinal failure.  During a 9-month shortage of intravenous selenium, all five who were previously selenium replete had deficiency identified (level <20 ng/mL).

After these deficiencies were identified, the patients were placed on Multitrace-5 (MTE-5).  This multivitamin contains 20 mcg/mL of selenium.  While patients prior to the shortage typically received 50-75 mcg/day, after instituting MTE-5, they received 10-26 mcg/day.  Nevertheless, this helped prevent any clinical evidence of deficiency.  In patients with selenium deficiency, there is an increased risk of cardiomyopathy, chronic illness, and death.

The authors note that their preference is to individually dose the specific trace elements and that MTE-5 can contribute to elevated levels of manganese and chromium with long-term usage.

Related blog links:

Related references:

  • -Gastroenterol 2009; 137: S61-S69.
  • -J Pediatr 2011; 159: 39.

6 thoughts on “Drug Shortages and Selenium Deficiency

  1. Is there any explanation on why the drug shortage exist? I’ve been told in the past it’s not just “market forces.” Propofol? Sodium Bicarb for mixing omeprazole suspension?

    • In the cited article, there is not a lot of information about the reasons for drug shortage. In a previous post on this blog, “Critical drug shortages in U.S.,” some of the reasons for drug shortages are discussed. You can search for this by typing “critical drug” in search window. I suspect that the referenced article has additional references. Also, in our institution, our lead pharmacist has a lot of information on this issue: jennifer.sterner-allison@choa.org. You could email her as well.
      Issues include profit margins, FDA regulations, & small number of manufacturers. Apparently, all of the trace metals in U.S. are about to expire in 2 weeks & hospitals cannot give expired medications.

  2. Pingback: TPN Drug Shortages -A Useful Reference | gutsandgrowth

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  4. Pingback: Connecting the Dots: Selenium and Keshan Disease | gutsandgrowth

  5. Pingback: Iodine Deficiency in Extremely Low Gestational Age Newborns Receiving Parenteral Nutrition | gutsandgrowth

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