Public health in pharmacy: improving vitamin D status in the U.S. population.

OBJECTIVES: To summarize the problem of vitamin D inadequacy in the United States and discuss how pharmacists can help improve vitamin D status in the population. SUMMARY: Vitamin D inadequacy has proven skeletal health effects and potential effects on other chronic conditions. The condition is present in many Americans. Adequate vitamin D intake is currently emphasized to prevent vitamin D inadequacy. However, overall dietary vitamin D intake and use of vitamin D supplements is relatively low in the United States. Pharmacists' health knowledge and placement in communities make them ideal resources for raising awareness on the benefits of vitamin D and providing nutrition information to prevent vitamin D inadequacy. However, pharmacists' ability to provide these services may be impeded in part by current limitations on compensation for health promotion activities. CONCLUSION: Health care reform is likely to expand pharmacists' scope of practice and services eligible for reimbursement. By promoting vitamin D in the communities they serve, pharmacists can take a lead role among health professionals in addressing vitamin D inadequacy.

Acute selenium toxicity associated with a dietary supplement.

BACKGROUND: Selenium is an element necessary for normal cellular function, but it can have toxic effects at high doses. We investigated an outbreak of acute selenium poisoning. METHODS: A case was defined as the onset of symptoms of selenium toxicity in a person within 2 weeks after ingesting a dietary supplement manufactured by "Company A," purchased after January 1, 2008. We conducted case finding, administered initial and 90-day follow-up questionnaires to affected persons, and obtained laboratory data where available. RESULTS: The source of the outbreak was identified as a liquid dietary supplement that contained 200 times the labeled concentration of selenium. Of 201 cases identified in 10 states, 1 person was hospitalized. The median estimated dose of selenium consumed was 41 749 microg/d (recommended dietary allowance is 55 microg/d). Frequently reported symptoms included diarrhea (78%), fatigue (75%), hair loss (72%), joint pain (70%), nail discoloration or brittleness (61%), and nausea (58%). Symptoms persisting 90 days or longer included fingernail discoloration and loss (52%), fatigue (35%), and hair loss (29%). The mean initial serum selenium concentration of 8 patients was 751 microg/L (reference range, < or =125 microg/L). The mean initial urine selenium concentration of 7 patients was 166 microg/24 h (reference range, < or =55 microg/24 h). CONCLUSIONS: Toxic concentrations of selenium in a liquid dietary supplement resulted in a widespread outbreak. Had the manufacturers been held to standards used in the pharmaceutical industry, it may have been prevented.