Continuing Education 繼續教育 成人微量營養素補充之臨床考量 臺安醫院 ( 台北 ) 藥劑科藥師廖清瑩 摘要 (micronutrient) - (vitamin) (trace element) 1310 micronutrientvitamintrace element 壹 前言 (micronutrient) (vitamin) (trace element) (cofactor) (U.S. Food and Nutrition Board, FNB) (Recommended Dietary Allowance, RDA) 134 9 1998FNB (Dietary Reference Intake, DRI) RDA (Estimated Average Requirement, EAR) 271 Mar. 31 2011 藥學雜誌第 106 冊 121
繼續教育 Continuing Education (Adequate Intake, AI) (tolerable Upper Limit, UL) 1 91 表一每日營養建議攝取量 脂溶性維生素 A 300-625 g 700-900 g 3000 g D 5-10 g 50 g E 12 mg 15 mg 1000 mg K 90-120 g 水溶性維生素 C (ascorbic acid 60-75 mg 75-90 mg 2000 mg B (folate) 320 g 400 g 1000 g B1 (thiamine) 0.9-1.0 mg 1.1-1.2 mg B2 (riboflavin) 0.9-1.1 mg 1.1-1.3 mg B6 (pyridoxine) 1.1-1.4 mg 1.3-1.7 mg 100 mg B12 (cobalamin) 2 g 2.4 g Niacin 11-12 mg 14-16 mg 35 mg Pantothenic acid 5 mg Biotin 30 g 微量元素 (Zinc) 6.8-9.4 mg 8-11 mg 40 mg (Selenium) 45 g 55 g 40 g (Copper) 700 g 900 g 10,000 g (Chromium) 20-35 g (Manganese) 1.8-2.3 mg 1984 (U.S. Food and Drug Administration, FDA) 2 FDA (American Society for Parenteral and Enteral Nutrition, ASPEN) 3 表二成人非腸道維生素使用之建議量 脂溶性維生素 A 1 mg D 5 g E 10 mg K 150 g 122 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.1 Mar. 31 2011
水溶性維生素 C 200 mg B1 6 mg B2 3.6mg B6 6 mg B12 5 g 40 mg 600 g 15 mg 60 g 表三成人微量元素使用之建議量 2.5-5.0 mg 20-60 g 0.3-0.5 mg 10-15 g 60-100 g 貳 吸收及交互作用 (lipase) (ileum) (duodenum) (jejunum) CEC EC EE AB6B2 (niacin) 4 表四藥物引起之微量營養素缺乏 A Mineral oil D Cholestyramine Phenytoin, Phenobarbital, carbamazepine CYP450D cholestyramine D D E Cholestyramine cholestyramine E 271 Mar. 31 2011 藥學雜誌第 106 冊 123
繼續教育 Continuing Education K Cholestyramine Neomycin K cholestyramine K K B1 Loop diuretics (spironolactone) B1 B6 Isoniazid (INH) B12 Proton pump inhibitorsh2 blockers INH Methotrexate, pyrimrthamine, tramterene Sulfasalazine Phenytoin Cholestyramine Zinc supplements Zinc oxide cream Thiazide diuretics B12 dihydrofolate reductase sideroblastic INH B6 B12 INHnicotinamide 參 微量營養素和發炎反應 ACE A B1B2B12 5 肆 影響維生素和微量元素需求量的因素一 生活形態 B1 124 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.1 Mar. 31 2011
6 二 疾病的發生 B6C K (B6CE) 7 AB1B6 B12 B12 (refeeding syndrome) 8 三 手術的進行 B12 (ADE K)B1B6 B12 9 伍 結論 (cachexia) 參考資料 : 1. Otten JJ, Hellwig JP, Meyers LD, eds. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: National Academies Press; 2006. 2. Food and Drug Administration (FDA) Parenteral multivitamin products; drugs for human use; drug efficacy study implementation; amendment. Federal Register. 2000; 65: 21200-21201. 3. A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force: Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002; 26(suppl): 22SA-24SA. Errata 2002; 26: 144. 4. Felípez L, Sentongo TA: Drug-induced nutrient deficiencies. Pediatr Clin North Am. 2009; 56: 1211-1224. 5. Swoboda SM, Lipsett PA: Intravenous iron as a risk factor for bacteremia in the surgical in- 271 Mar. 31 2011 藥學雜誌第 106 冊 125
繼續教育 Continuing Education tensive care unit patient. Surg Infect. 2005; 6: 158. 6. Johnson KA, Bernard MA, Funderburg K: Vitamin nutrition in older adults. Clin Geriatr Med. 2002; 18: 773-799. 7. Story DA, Ronco C, Bellomo R: Trace element and vitamin concentrations and losses in critically ill patients treated with continuous venovenous hemofiltration. Crit Care Med. 1999; 27: 220-223. 8. Crook MA, Hally V, Panteli JV: The importance of the refeeding syndrome. Nutrition. 2001; 17: 632-637. 9. Abell TL, Minocha A: Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006; 331: 214-218. Clinical Micronutrient Supplementation in Adult Nutrition Therapy Ching-Ying Liao Department of pharmacy, Taiwan Adventist Hosptal Abstract Micronutrient (vitamins and trace elements) deficienciesare often present in hospitalized patients. Deficiencies occur due to inadequate administration, increased requirements, and increased losses, affecting various biochemical processes and resulting in organ dysfunction, poor wound healing, and altered immune status. Guidelines for the 13 essential vitamins and 10 essential trace elements have been established. These recommendations, however, are not to critically ill patients. Most enteral nutrition preparations contain adequate amounts of vitamins and trace elements, although bioavailability may be an issue. Clinicians think of micronutrients should not as nutritional supplements alone but also as therapeutic agents. 七彩 126 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.1 Mar. 31 2011