Objective: The supply of trace elements is ensured by standard composition of additions to parenteral nutrition and/or as a componed of ingredients to enteral nutrition.Nevertheless, it was repeatedly stated that with already developed depletions or contemporary increased loss the standard supplementation is insufficient. Clinical trials in intensive care patients demonstrate early depletion of selenium (Se) as well as zinc (Zn) and favourable effect of their supplementatin in higher doses than usual. In our clinical trial we wanted to determine the serum levels of both trace elements, their relation to the acute phase reaction and to take a view to the therapy. Material and Methods: Two groups of patients were investigated. The 1st group: 18 cardiosurgical patients operated on extracorporeal circulation. They were investigated last day before the surgery and the 1st, 3rd and 7th day after the surgery. There was no supplementation of Se or Zn. The 2nd group: 37 patients of ICU of anesthesiologic clinic hospitalized in various stages of metabolic response to trauma. They were examined on the 1st, 3rd, 5th and 7th day after their admission to the ward. The mean daily intake of Se was 0.9 µmol and of Zn 107 µmol. Laboratory investigation in mentioned days included serum Se, Zn, C-reactive protein (CRP) and further parameters used for the calculation of the prognostic inflammatory nutritional index (PINI), PINI = (CRP • orosomucoid):(albumin • prealbumin). Results: In the 1st group the serum Zn levels decreased significantly from physiological levels the 1st day after surgery and in the following days returned gradualy towards the reference values. In the 2nd group, the serum Zn levels were permanently decreased. In the 1st group, the negative correlation Zn:CRP was found. In the 1st group the serum Se levels were decreased already before surgery and thereafter the values continued to fall. In the 2nd group the Se decrease was even more significant. During the investigated period the values increased, but nevertheless remained below the reference limit. Significant negative Se:CRP correlation was found in both groups as well as negative Se:PINI correlation in the 2nd group. Conclusion: Serum Se and Zn levels significantly decreased in both groups of patients. They were more frequently in significant relation to CRP than to PINI. The influence of acute phase reaction, as well as of depletion of both micronutrients are probable. Literature demonstrates the fovourable effect of higher then standard supplemention of Se with respect to (i) mortality in most severely critically ill; (ii) frequency of renal failure; (iii) infection complications; and (iv) decrease of lipid peroxidation markers. From such reasons, in hyposelenemic patients with systemic inflammatory response syndrome (SIRS) and with sepsis we started the supplementation of Se in higher than standard doses. Se in serum, glutathioneperoxidase in blood and further parameters of acute phase were monitored.

        Key words: selenium, zinc, trace elements, micronutrients, intensive care, sepsis, SIRS.