: : : : 27372181-8443 62 : 252 / / ADH receptor antagonistsvaptans / 102 7-102 9 98% (Hypokalemia) 3.5 meq/l ( ) ( )
(3.0~3.5 meq/l) (2.5~3.0 meq/l) ( 2.5 meq/l) (digoxin) (Serum potassium) (Urine potassium) 24
( ) () β2-adrenergic agonist nebulized albuterol 0.2~0.4 meq/l 1 (Pseudoephedrine) (Ritodrine) (Terbutaline) 4-6 2.5 meq/l () (Xanthine)Theophylline Caffeine 也 會 抑 制 細 胞 的 磷 酸 酯 解 酶 (phosphodiesterase) Na+/K+- ATPase thophylline () (Insulin) () (Diuretics) Thiazide (loop diuretic) ( ) furosemidebumetanide ( ) () Penicillin 苷 (aminoglycoside) (antineoplastic) (antiviral) ( ) () (Corticosteroids) (mineralocorticoids) (glucocorticoids) ( ) () 1. 10 meq/ 55-65 meq/
2. 3. (cushing's syndrome) 4. (aldosterone) sodium bicarbonate (Transcellular Shift) β2-receptor agonists Epinephrine Albuterol Terbutaline Salmeterol Ephedrine Pseudoephedrine Tocolytic agents Ritodrine Theophylline Caffeine Insulin overdose (Enhanced Renal Excretion) Diuretics Acetazolamide Thiazides Indapamide Furosemide Ethacrynic acid High-dose penicillins Ampicillin Penicillin Nafcillin Steroids Mineralocorticoids Miscellaneous Aminoglycosides Amphotericin B Cisplatin (Enhanced Fecal Elimination) Sodium polystyrene sulfonate Phenolphthalein Sorbitol
Acetazolamide Amphotericin β2-receptor agonists Cisplatin Corticosteroid K + ( ) K + K + K + Na + K + H + Insulin and glucose Penicillin(Carbenicillin, piperacillin, ticarcillin) Aminoglycosides(Gentamicin) Thiazide and loop diuretic K + Na + K + K + K + Na + Na + -K + Na + [K]>3mEq/L 1mEq/L 100~200mEq [K]<3mEq/L 1mEq/L 200~400mEq 15% 30~40ml/day g 13.4 mmol 20mEq/hr
5% 500 ml 15% 510 ml (Potassium chloride) (potassium phosphate) (potassium bicarbonate) ( ) 40~100 mmol 400 meq ( 3 meq/kg) 40~60 2.5 meq/l 200 meq 30 meq/l 10 2mEq/L 400 meq 20 meq 1. 2. Cl - ( ) 3.
24 1. 2. ( ) (>1000 mg/100 g) (>500 mg/100 g) (>250 mg/100 g)
1. Pharmacotherapy Handbook - A Patient-Focused Approach 7th ed. Section 14 Renal Disorders. Chapter 78 Electrolyte Homeostasis. P891-894 2. Pharmacotherapy- A Pathophysiologic Approach, 7th ed. Section 5 Renal Disorders. Chapter 54 Disorders of Potassium and Magnesium Homeostasis. P877-881 3. Uptodate-Hypokalemia 4. Lin SH, Halperin ML. Hypokalemia: a practical approach to diagnosis and its genetic basis. Curr Med Chem 2007; 14:1551-65 5. 20102131-39
37 1 (very low birth weightvlbw 1500 g) (feeding intolerance) (gastric residuals) (necrotizing enterocolitisnec) 1 Low-birth weight infants weigh. Very low-birth weight infants weigh. Extremely low-birth weight infants weigh <2,500 g <1,500 g <1,000 g
Basal Energy ExpenditureBEE ( ) 80 100 kcal/kg/day 30 40 kcal/kg/day (nonprotein calorie to nitrogen ratio, NPC/N) 150-200 kcal/g( 2) 55 30 15 2 (nonprotein calorie to nitrogen ratio, NPC/N) NPC/N(kcal/g) NPC/N(kcal/g) 1501 ( ) 801 1501 1501 ( ) 1551 801
3 3 (ml/kg) BW1250 g BW1250 g 1 100 75 60-80 2 100-120 75-100 70-90 3 100-150 100-150 80-100 4 100-150 100-150 100-120 5 100-150 100-150 120-140 ( 24 45 mg/dl 50 mg/dl) 5-8 mg/kg/min 5~6 mg/kg/min 1~2 mg/kg/min 11 ~ 12 mg/kg/min ( <1000g) 3.5mg/kg/min 1~2 mg/kg/min 12 mg/kg/min
(intraventricular hemorrhage) 12.5% 30% isoleucineleucinelysinemethionine phenylalaninethreoninetryptophan valine cysteineglutamineglycinehistidinetaurine tyrosine (hyperammonemia) (azotemia) 2~3 g/kg/day 3.5~4 g/kg/day (triglycerides) (phospholipids) (glycerol) (mediumchain triglycerides, MCTs ) MCTs (longchain triglycerides, LCTs )
20% 10% 10% 60% 0.5 g/kg/day 1 g/kg/day 0.25 ~ 0.5 g/kg/day 3 g/kg/day TG>400 mg/dl 4 TG>150 mg/dl TG>250 TG>350 mg/dl 4 (bone mineralization) (demineralization) ph 4 Preterm/Neonates Infants/Children Adolescents/Children >50kg Na 2-5 meq/kg 2-5 meq/kg 1-2 meq/kg K 2-4 meq/kg 2-4 meq/kg 1-2 meq/kg Ca 2-4 meq/kg 0.5-4 meq/kg 10-20 meq/day
Phos 1-2 mmol/kg 0.5-2 mmol/kg 10-40 mmol/day Mg 0.3-0.5 meq/kg 0.3-0.5 meq/kg 10-30 meq/day Acetate As needed to maintain acid-base balance Chloride As needed to maintain acid-base balance 5 5 2.5 kg >2.5 kg Zinc 400 mcg/kg 250 mcg/kg Copper 20 mcg/kg 10 mcg/kg Chromium 0.4 mcg/kg 0.1 mcg/kg Manganese 1 mcg/kg 2.5 mcg/kg Selenium 2 mcg/kg 1.5 mcg/kg 6 6 早 產 兒 於 靜 脈 營 養 之 综 合 維 生 素 他 命 每 日 建 議 使 用 量 Current regimen Estimate based Maximum not to based upon upon the needs exceed term infant pediatric of premature (unit/day)
multivitamin formulation (unit/kg/day) infants (unit/kg/day) A (microg) 280 500 700 E (mg) 2.8 2.8 7 K (microg) 80 80 200 D (microg) 4 4 10 C, Ascorbic acid (mg) 32 25 80 B1, Thiamin (mg) 0.48 0.35 1.2 B2, Riboflavin (mg) 0.56 0.15 1.4 B6, Pyridoxine (mg) 0.40 0.18 1 Niacin (mg) 6.8 6.8 17 Pantothenate (mg) 2 2 5 Biotin (microg) 8 6 20 Folate (microg) 56 56 140 Vitamin B12 (microg) 0.40 0.30 1 Heparin Heparin 0.5-1units /ml Heparin (lipoprotein lipase)
(necrotizing enterocolitis) -- (Bronchopulmonary dysplasia, BPD) 1. Parenteral nutrition in premature infants, 2013 Uptodate. 2. The A.S.P.E.N. Pediatric Nutrition Support Core Curriculum.2010. 3. Guidelines for Acute Care of the Neonate 20th Edition, 2012 2013
ADH receptor antagonistsvaptans Hyponatremia <135mmol/LmEq/L < 275 mosm/kg ECF aldosterone 120 meq/l120 meq/l 120 meq/l SIADH 100 meq/l Antidiuretic Hormone ADH ADH SIADH SIADH ADH ADH TCAs SSRIscarbamazepinechlorpropamide alkylating agents hypovolemia euvolemia hypervolemia
hypovolemia TBW Na hypertonic usually: thiazide>loop diuretics osmotic diuresisglucose, urea, mannitol euvolemia TBW Nahypotonic SIADH ex. Addison disease SSRI, diuretics, barbiturates, carbamazepine, clofibrate, opioids, tolbutamide, vincristine, akylating agentspossibly: clclophosphamide, NSAIDS, oxytocin hypervolemia TBW Na hypotonic SIADH 0.9% 1 meq/l 2 meq/l/first 2-3 hr 120 129 meq/l 8001000 ml/day 3% salinecontain Na 513 meql/l +/- loop diuretic,+/- KCl vasopressin receptor antagonist 3% SIADH Osmotic Demyelination Syndrome ODS
3% 46 meq/l 9 meq/l/first 24 hrsgrade 1B 0.9% SIADH 3% Desired change in Na TBW Total Body WaterTBW =0.6 body weightkg =0.5 body weightkg =0.45 body weightkg 0.250.33 meq/l/hr 0.5mEq/L/h 0.5mEq/L/h 70kg 106mEq/L 112mEq/L 112-106 0.6 70 252 meq 3% saline 513 meq/l 252 5130.5 L 3% saline 0.5mEq/L/h 112-106 6mEq 6 0.5 =12 hr 3% saline 12 demeclocycline ADH 20-40% NDInephrogenic diabetes insipidus demeclocycline ADH NDI
loop vaptans (usually acute or <115) (usually chronic or >120) 8001000 ml/day 3% saline +/- loop diuretic,+/- KCl furosemide SIADH Vaptans Demeclocycli n Thyroid replacement therapy Corticosterlids Furosemide Vaptans & SIADH present Vaptans ADH angiotensin II ADH ADH V 1a V 2 Vaptans ADH V 2 diuretics vaptans aquaretics V 2 SIADH
aquaretics diuretics GFR renin BUNsCr ADH receptor antagonistsvaptans vaptans FDA Tolvaptan Conivaptan Tolvaptan Tolvaptan TolvaptanSamsca 15mg 1. Tolvaptan SIADH <125 meq/l 125 2. Tolvaptan <125 meq/l SALT tolvaptan 15 mg 30 mg 24 60 mg 24 30 Clcr 10 ml/min Clcr <10 ml/min 13% 11%
Conivaptan Conivaptan Vaprisol 20 mg 100 ml hypervolemic euvolemia 20 mg 30 20mg 24 0.83mg/hr 24 40mg/day1.7mg/h 4 Note: If patient requires 40 mg/24 hours, may administer two consecutive 20 mg/100 ml premixed solutions over 24 hours ie, 20 mg over 12 hours followed by 20 mg over 12 hours Clcr 30 ml/min Clcr <30 ml/min anuria 10mg 20mg/day 4 hypovolemia Tolvaptan ADH V 2 SIADH 2013/04 30 1300 11.2 8,190 Conivaptan ADH V 2 SIADH 4 hypovolemia 20mg load IV 20mg/day IV 573 CYP3A4 eg, Ketoconazole, Itraconazole, Ritonavir, Indinavir, Nelfinavir, Saquinavir, Nefazodone, Telithromycin, Clarithromycin vaptans
2013 FDA tolvaptan tolvaptan Conivaptan Tolvaptan Lixivaptan Satavaptan Non-selective V2 & V 1a V 2 selective V 2 selective V 2 selective IV Oral Oral Oral Vaprisol Samsca Lixar 2012/09 FDA Astellas Otsuka Pfizer Sanofi 20mg/day; max:40mg/day 15mg/day loading dose; max: 60mg/day Clcr 30 ml/min Clcr 10 Clcr ml/min <30 ml/min anuria Clcr <10 ml/min CYP3A4 inhibitor & inducer vaptans
1. FDA : Samsca (tolvaptan) Drug Warning - Potential Risk of Liver Injury 2. Uptodate Hyponatremia 3. Clin Ther. 2010 Jun;32(6):1015-32. Treatment of hypervolemic or euvolemic hyponatremia associated with heart failure, cirrhosis, or the syndrome of inappropriate antidiuretic hormone with tolvaptan: a clinical review. Nemerovski C, Hutchinson DJ. Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
102 7-102 9 ( ) ( ) Showmin eye drops ONSD 0.01% 1. 0.01% 10ml/bot 2. 0.01%Neostigmine5ml/bot 5ml/bot(Neostigmine) (Neostigmine) 3. (TSHO) (TONSD) Duasma HFA 10ml Duasma MDI 10ml 1. (Budesonide) (Budesonide) 2. 200mcg/puff200dose/bot (TDUA-H) (TDUA1) 3. LACTUL SYRUP 300ml (Lactulose) (LLACT) Vitamin B6 Tablets 10mg (Pyridoxine HCl) (OVB6) Zodenox F.C. 10mg (Zolpidem ) (OZOD) Radi-K 595mg (Potassium chloride) (ORAD) Lamvita (Bcomplex)20ml (ILAM) Gibicef 1000mg/vial (Cefuroxime) (IGIBI) Voren-K SC 25mg (Diclofenac potassium) (OVOR-K) Tamso SR 0.2mg (Tamsulosin HCl) (OTAMS) LACOLY 300ml (Lactulose) (LLAC) Vitamin B6 10mg (Pyridoxine HCl) (OVITB6) Zolpi F.C. 10mg (Zolpidem ) (OZOLP) Slow K 600 mg (Potassium chloride) (OSLO) Pyricobamin(Bcomplex)20ml (IPYRI) Uroxime 1000mg/vial (Cefuroxime) (IUROX) Cataflam 25mg (Diclofenac potassium) (OCATA) Hanlosin SROD 0.2mg (Tamsulosin HCl) (OHAN) 1. 2. 1. B6 2. 1. 2. 1. 2. 1. 2. ( ) 3. Thiamine 50mg,Pyridoxine 100mg, B12 1mg/20ml 1. 2. 1. 2. 1. ( ) 2. 3.
( ) ( ) Econazole VT 150mg Antifungal VT 1. (Econazole) 100mg (Miconazole) (TECO) (TANV) 2. Folina inj.(leucovorin)50mg (Leucovorin) (IFOL) CIPROXIN INF 200mg(Ciprofloxacin ) (ICIP200) Calciumfolinat- Ebewe100mg (Leucovorin) (ICAL-F) CIPROXIN INF 100mg (Ciprofloxacin) (ICIP) 3. Econazole nitrate 150mg/supp 3 1. (Methotrexate) 2. 3. 10mg/ml50mg/vial 1. CIPROFLOXACIN (1-17 ) (5-17) ( ) 2. 3. 200mg/100ml/vial ( ) ( ) Varivax MSD Varilrix (Varicella 1. (Varicella virus virus vaccine live) vaccine live) (IVARIV) (IVARI) ( ) Viramune XR 400mg (Nevirapine) 1. (OVIR400) HIV-1
( ) NITHIODOTE 1. (INITH) 2. Sodium Nitrite 300mg/10mL/Vial + Sodium Thiosulfate 12.5 g/50ml/vial 3. ( ) ( ) Elonva 1. 100ug/0.5ml GnRH antagonist (Corifollitropin alfa) 2. (IELON) Inlyta 1mg 1. sunitinibcytokine (Axitinib) 2. (OINL) XARELTO FC 1. (1) (non-valvular atrial fibrillation) Tab 15mg (Rivaroxaban) (systemicembolism) 75 (OXAR15) (transient ischemic attack) (2) Orencia 250mg 1. (1) Orenciamethotrexate (Abatacept) [ (IORE) methotrexate (MTX) (TNF) ] (2) Orenciamethotrexate [ (TNF) ] 6 6 **Orencia 6 (3) Orencia (RA) Prolia 60mg 1. (Denosumab) (IPRO06) Prolia