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It's made by special pharmacies that mix it up in different ways to help with shortages or to give patients exactly what they need, like a smaller dose or a different form

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These effects can lead to dehydration, electrolyte imbalances, or reduced nutrient absorption

Curr Med Res Opin 26(4):911921

A meta-analysis showed that selenium levels in the water, soil, cereal, and corn in KBD endemic regions were lower than they were in non-endemic regions, supporting the fact that the level of selenium in tissue is predominantly affected by dietary intake 23