title: Two fatal cases of selenium toxicity.
abstract: Two patients, a 36-year-old female and a 36-year-old male, separately experienced new onset nausea, vomiting, diarrhea, abdominal pain, muscle weakness and pallor. Over a period of 14-16 h these symptoms continue and progress to include hypotension refractory to therapy, pulmonary edema and cardiovascular collapse. Autopsies show hemorrhagic pulmonary edema, splenomegaly and lack of anatomical cause for sudden death. Postmortem analysis, in one case post-embalming and exhumation, revealed elevated selenium concentrations and a determination of the cause of death. These two cases present several important features associated with selenium toxicity, two of which are previously unreported: (1) selenium as a potential homicidal agent, (2) the toxidrome and time frame of selenium toxicity, (3) selenium determination in exhumed, embalmed tissues, (4) postmortem urinary selenium concentration, and (5) decrease in tissue concentrations over time.
authors.affiliation: Kentucky Regional Poison Center, PO Box 35070, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: Eric
authors.initials: E
authors.lastname: Pfiefer
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D003967:Diarrhea / Q000139:chemically induced; D049249:Exhumation; D005260:Female; D053593:Forensic Toxicology; D006470:Hemorrhage / Q000139:chemically induced / Q000473:pathology; D006708:Homicide; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D018908:Muscle Weakness / Q000139:chemically induced; D009325:Nausea / Q000139:chemically induced; D010167:Pallor / Q000139:chemically induced; D011180:Postmortem Changes; D011654:Pulmonary Edema / Q000139:chemically induced / Q000473:pathology; D012643:Selenium / Q000493:pharmacokinetics / Q000506:poisoning*; D013054:Spectrophotometry, Atomic; D013163:Splenomegaly / Q000139:chemically induced / Q000473:pathology; D014131:Trace Elements / Q000493:pharmacokinetics / Q000506:poisoning*; D014839:Vomiting / Q000139:chemically induced
chemical_list: D014131:Trace Elements; D012643:Selenium