Rare Case of Selenite Poisoning Manifesting as Non–ST-Segmen
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A 74-year-old female patient presented in chest pain unit (University Hospital Heidelberg, Germany) with acute onset of angina pectoris. She regularly consumed nutrition supplements, including sodium selenite capsules as a cardiovascular preventive measure. On the day of hospitalization, she ran out of selenite capsules and took sodium selenite powder from her husband’s laboratory as a substitute.

The patient mistakenly consumed 125 mg, which is 1,000 times the capsule dose of 125 µg. Shortly after sodium selenite ingestion, she experienced worsening of her health condition. At first, she noted slight dizziness and trembling. Within 1 hour, she had chest pain radiating to the left arm and jaw, as well as vomiting, severe nausea, and soft, frequent bowel movements.

There was no collapse or syncope, fever, cough or dyspnea, and no abdominal pain. At the time of admission, the patient had bradycardia and elevated blood pressure (heart rate, 52 beats/min; blood pressure, 180/90 mm Hg).

The patient’s medical history included multiple orthopedic conditions and operations, as well as bronchial asthma, various allergies, euthyroid goiter, and Ménière’s disease. Until the day of admission, the patient was not known to have any cardiovascular diseases. Her treatment included levothyroxine, sulpiride, and food supplements such as Ginkgo biloba.

After admission to the chest pain unit, an electrocardiogram (ECG) and troponin assessment were performed. There were no signs of ischemia on the ECG. At first blood draw, the high-sensitivity troponin T (hsTnT) level was 56 ng/l, rising to 216 ng/l at the 3-h control, thus indicating an acute non–ST-segment myocardial infarction or an acute myocardial injury secondary to severe selenium poisoning. No inflammatory constellation and signs of liver or kidney damage were found in the blood tests.

Given that the patient had reservations about undergoing coronary angiography and the symptoms were clearly associated with the selenium intoxication, coronary computed tomography was performed. The imaging showed only mild to moderate isolated left anterior descending artery disease. The patient explicitly rejected further invasive examination, and cardiac magnetic resonance had to be aborted before administration of the contrast agent because of claustrophobia. In the acquired sequences a normal-sized left ventricle with globally normal systolic function was found, concordant with echocardiography. Pulmonary function testing did not reveal any relevant findings, except for a slightly limited diffusion capacity. Upper abdomen sonography showed fatty liver disease and a renal cyst on the left side.

Source: https://www.sciencedirect.com/science/article/pii/S2666084921001388#
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