Abstract
The second part of the communication on the issue of trace elements in critically ill patients is devoted to copper and selenium. After a short decrease in trauma, as well as in systemic inflammation, plasmatic level of copper increases.
The copper is bound on ceruloplasmin, which is an acute phase reactant. Copper deficiency requiring substitution occurs in extensive burns, losses from the gastrointestinal tract or in negative balance during haemodialysis.
Copper is necessary for the utilization of iron in the formation of haemoglobin and transferrin and therefore the insufficient level results to hypochromic anaemia. The authors present the recommended doses for copper supplementation in the aforementioned losses.
Selenium possesses a number of functions important for the surviving of critical illness, including protection from the organic peroxides, the conversion of thyroxine to active triiodothyronine, improvement in response to glucocorticoids, glycaemic control, inhibition of adhesion molecules and the effect on the function of T-lymphocytes. The level of selenium is reduced in systemic inflammation and it falls progressively depending on the severity of condition (e.g. sepsis).
The article reports a number of clinical trials with different regimens of supplementation with high doses of selenium, administered for maximal period of two weeks. The mortality rate has dropped significantly so far in one large clinical trial only.
Some other trial have reported positive results in some outcomes: SOFA score improvement in patients with multiple organ dysfunctions, elevation of previously low cholesterol, praealbumin and glutathione peroxidase levels, and reduction in C-reactive protein values. The optimal therapeutic doses are discussed in detail.
The toxic effects of copper and selenium overdose, which can cause a critical condition per se, are mentioned.