Selenium is a naturally occurring substance that is toxic at high concentrations but is also a nutritionally essential element. Hydrogen selenide is the most acutely toxic selenium compound. Acute (short-term) exposure to elemental selenium, hydrogen selenide, and selenium dioxide by inhalation results primarily in respiratory effects, such as irritation of the mucous membranes, pulmonary edema, severe bronchitis, and bronchial pneumonia. Epidemiological studies of humans chronically (long-term) exposed to high levels of selenium in food and water have reported discoloration of the skin, pathological deformation and loss of nails, loss of hair, excessive tooth decay and discoloration, lack of mental alertness, and listlessness. Epidemiological studies have reported an inverse association between selenium levels in the blood and cancer occurrence and animal studies have reported that selenium supplementation, as sodium selenate, sodium selenite, and organic forms of selenium, results in a reduced incidence of several tumor types. The only selenium compound that has been shown to be carcinogenic in animals is selenium sulfide, which resulted in an increase in liver tumors from oral exposure. EPA has classified elemental selenium as a Group D, not classifiable as to human carcinogenicity, and selenium sulfide as a Group B2, probable human carcinogen.