Davis Cheryl, Javid Patrick J, Horslen Simon
Seattle Children's Hospital, Seattle, Washington.
JPEN J Parenter Enteral Nutr. 2014 Jan;38(1):115-8. doi: 10.1177/0148607113486005. Epub 2013 Apr 15.
Parenteral nutrition (PN) is a lifesaving therapy for children with intestinal failure and can now be used chronically without the life-threatening complications of the past. Adequate intravenous trace element supplementation is required as part of a complete nutrition prescription. According to the U.S. Food and Drug Administration (FDA), the number of drug shortages, including sterile injectable agents used as PN components, has increased since 2010. Selenious acid as an individual additive was recently unavailable at our institution for 9 months due to a national shortage.
To assess the impact of the selenious acid shortage, we retrospectively compiled data from existing clinical records for eligible patients. We included children with intestinal failure on full PN support who were older than 1 year at the onset of the selenium shortage. Whole-blood selenium concentrations prior to the selenious acid shortage were compared with concentrations drawn during the shortage.
Five patients with intestinal failure and complete PN dependence were identified, and all 5 patients had normal serum selenium concentrations prior to the shortage. All 5 patients developed severe biochemical selenium deficiency in direct correlation with the shortage of selenium. No morbidity associated with selenium deficiency was observed. Selenium concentrations recovered after selenium supplementation was reinstituted.
A national selenious acid shortage was associated with biochemical selenium deficiency in a cohort of children with intestinal failure. Despite very low selenium concentrations, none of our patients exhibited clinical signs of deficiency.
肠外营养（PN）是治疗肠衰竭患儿的一种挽救生命的疗法，现在可以长期使用，而不会出现过去那种危及生命的并发症。作为完整营养处方的一部分，需要进行充分的静脉微量元素补充。根据美国食品药品监督管理局（FDA）的数据，自2010年以来，包括用作PN成分的无菌注射剂在内的药品短缺数量有所增加。由于全国性短缺，我院最近有9个月无法获得亚硒酸这种单一添加剂。
为评估亚硒酸短缺的影响，我们回顾性收集了符合条件患者的现有临床记录数据。我们纳入了在硒短缺开始时年龄大于1岁、接受全肠外营养支持的肠衰竭患儿。将亚硒酸短缺前的全血硒浓度与短缺期间采集的浓度进行比较。
确定了5例肠衰竭且完全依赖肠外营养的患者，所有5例患者在短缺前血清硒浓度均正常。所有5例患者均出现严重的生化性硒缺乏，且与硒短缺直接相关。未观察到与硒缺乏相关的发病情况。重新补充硒后，硒浓度恢复正常。
全国性的亚硒酸短缺与一组肠衰竭患儿的生化性硒缺乏有关。尽管硒浓度极低，但我们的患者均未表现出缺乏的临床症状。
