加護病房查房日誌20200722
不知道大家看完了默默奉獻的灰姑娘藥師的第一集嗎?
其中有個場景是有個被蜜蜂叮的病人,過敏休克入院,一直打腎上腺素都沒有辦法?
後來葵藥師發現病人使用beta-blocker就是乙型阻斷劑,請問醫師是否需要施打昇糖素,就是glucagon。
這裡老師來跟大家說明一下,beta-blockers單獨或合併所謂的angiotensin-converting enzyme inhibitors曾經被報導過可能使的過敏更嚴重有關。
但是另一個789個病人的回溯性研究發現,其實使用beta blocker並不一定會增加需要腎上腺素或是額外腎上腺素劑量的情況,所以其實臨床的影響相對是小的。
但是一旦發現使用腎上腺素不太有效,而且病人也有吃beta blockers,那就可以考慮使用glucagon,就像影片演的那樣子,原因是當你吃了beta blockers,可能會蓋住了腎上腺素作要在beta receptor的作用,所以強心或升壓的效果就不好了。
那成年人的劑量要怎麼給呢?
可以1 to 5 mg 緩慢IV bolus五分鐘,也可以持續用5 to 15 mcg/minute慢慢增加劑量到效果。
此外要注意,這是影片沒有演出來的,快速施打glucagon可能會誘導嘔吐,所以保護呼吸道是很重要的,影片中的病人也是有插管啦,所以也OK,如果沒有的話,可能就要用復甦姿勢比較OK。
有使用過glucagon的同學,歡迎在底下留言+1
同時也有1部Youtube影片,追蹤數超過4,270的網紅Maxine Chan,也在其Youtube影片中提到,hello my fellow fatties! HAHAH if you clicked into this video, you're probably looking to see what type of food/snacks you could order online sooo, we...
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mcg to mg 在 Mordeth13 Facebook 的最佳貼文
I find this interesting and scary. Can any of you ease my mind and dispel this?
Mercury Myth: Only a trace amount of thimerosal is used when added to vaccines.
Truth: Thimerosal is added at a concentration of 1:10000. That is equivalent to 100,000 parts per billion (ppb). Half of thimerosal (C9H9HgNaO2S) is mercury. That makes 50,000 ppb mercury in the vaccine.
• 2 ppb mercury is the mandated limit in drinking water
• 200 ppb mercury in liquid waste renders it a toxic hazard
• 25,000 ppb is found in infant flu shots
• 50,000 ppb is found in regular flu shots — recommended for children, pregnant women, the elderly...
In different terms, there are 250,000 nanomolars Hg in a 0.5 ml flu shot.
It only takes 4 nM Hg to cause failure in the dendrites responsible for immune response and to cause cell death in brain neurons.
Thimerosal is toxic to developing neurons at 1 nM (1 ppb).
In other words, exceptionally low levels of thimerosal can impede neuron growth and function without actually killing the neurons.
http://www.vaccinesafety.edu/thi-table.htm
Myth: Ethylmercury from a vaccine is less toxic than methylmercury from fish or the environment.
Truth: A paper published in 2005 showed that baby primates injected with ethylmercury retain twice as much inorganic mercury in their brains as primates exposed to equal amounts of ingested methylmercury.
Both are forms of organic mercury. Organic converts to inorganic inside cells and becomes trapped. The cells start failing.
Here is a video of mercury's effect on neurons.
https://www.youtube.com/watch?v=XU8nSn5Ezd8
Here is a table of thimerosal content in currently licensed vaccines according to the FDA.
http://www.vaccinesafety.edu/thi-table.htm
The table lists 'trace amounts' of thimerosal ranging from 0.00012% to 0.0033%.
That's equivalent to 1,200 ppb to 33,000 ppb.
Research shows thimerosal is toxic to neurons at 1 ppb.
Those 'trace amounts' are still 4 to 5 orders of magnitude higher.
Other vaccines are listed as ‘thimerosal-free’ or ‘mercury-free’.
But thimerosal is still used in the production process for many of those vaccines, after which an effort is made to filter it out.
Unfortunately the mercury has already bonded to proteins used in the vaccines and cannot be completely removed.
There is no safe level of mercury exposure.
http://www.fda.gov/…/SafetyAvailab…/VaccineSafety/UCM096228…
In 2004 the CDC's Chief of the Organic Analytical Toxicology Branch gave a presentation to the Institute of Medicine (IOM).
On page 21 he showed the following chemicals linked to Autism Spectrum Disorders (ASD) — thimerosal, thalidomide, lead, ethanol, valproic acid, and retinoids.
Some more math
So how much does “trace” mean? According to the CDC, it says less than or equal to 0.3mcg per dose.
Also the math on how many ppb in a “thimerosal free” vaccine:
0.3 mcg / 0.5mL =
0.3 mcg / .0005L =
…3,000 mcg / 5L =
600 mcg / L
1 mg/KG = 1 PPM (formal definition of PPM)
1 L = 1 KG (density of water or saline solution)
1 mcg/L = 1 PPB (because 1 KG and 1 L of water are equivalent)
THEREFORE:
600 mcg / L =
600 ppb Thimerosal in the “thimerosal-free” vaccine
Flu vaccine has “only” 25 mcg Thimerosal. The shot is 0.5mL. Let’s do some math:
25 mcg / 0.5mL =
25 mcg / .0005L =
250,000 mcg / 5L =
50,000 mcg / L
1 mcg / L = 1 ppb, therefore
The shot has 50,000 ppb of Thimerosal
Remember that 2 ppb mercury is the mandated limit in drinking water and normally 200 ppb would label something a toxic hazard.
So, in THIS study the reality shows that even though ethyl mercury may be excreted and or detoxed faster than methyl mercury, actually they both are potentially neuro-toxic and well potentially cumulative. How much ethyl mercury is left in the brain and other organs of the body, ir-regardless of the rate of assumed detox?
Arch Toxicol. 1985 Sep;57(4):260-7.
The comparative toxicology of ethyl- and methyl mercury.
Magos L, Brown AW, Sparrow S, Bailey E, Snowden RT, Skipp WR
http://www.ncbi.nlm.nih.gov/pubmed/4091651
‘Mercury is known to be neurotoxic and has effects on the immune system as well. Mast cells are involved in allergic reactions, and also in inflammation, and innate and acquired immunity. Autistic individuals have a 10-fold greater number of hyperactive mast cells in most tissues. Mercury stimulates vascular endothelial growth factor and interleukin (IL)-6 release from mast cells. These mediators could disrupt the blood–brain barrier and cause brain inflammation (Kempuraj et al., 2010)’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850891/
http://www.sailhome.org/Concerns/Vaccines/Thimerosal.html
mcg to mg 在 加護病房查房日誌 Facebook 的最佳貼文
加護病房查房日誌20171128
今天來跟大家介紹一個藥品,Pyrazinamide (PZA),沒錯,就是抗結核病的用藥(通常是前兩個月的治療),今天老師不講數字拳,要講這個藥品的簡介。會和Rifampin, INH, EMB等並用,單獨使用無效。
相對其他藥品,PZA的抗菌範圍比較窄,主要是對抗Mycobacterium tuberculosis and Mycobacterium africanum。此藥會透過pyrazinamidase (PZase)轉化為pyrazinoic acid,這個才是活性物。作用機轉未明,推論會抑制M. tuberculosis的fatty acid synthetase I (FASI) enzyme,屬於抑菌性藥品。
PZA口服吸收快速,波峰濃度約1-2小時達到,和飯吃影響不大,在過往的研究中指出,給予25 mg/kg 劑量,血中濃度可達30 to 50 mcg/mL。PZA在體中分布很廣,分布體積約0.6 to 0.7 L/kg,而且在肺內的濃度很高,也可以分布到腦脊髓液中,細胞內外濃度類似,小孩子的話,漢成人相比有較大的分布體積和較慢的吸收與排除。
另外PZA在肝臟代謝廣泛,約70%會變成代謝物後排除到尿意中,在正常肝腎功能的人,半衰期約9-10小時,也會經過洗腎排出。
劑量的部分,成人每日劑量約20 to 25 mg/kg(最大可到2g),腎功能不良的病人要調整,在creatinine clearance <30 mL/min or洗腎病人,劑量為25 to 35 mg/kg per dose 每周三次洗腎後給。在腎功能不全的病人會增加高尿酸血症的風險。肝功能不好可能需要調整劑量,但目前已發表的準則並沒有一個統一的建議。
副作用的部分,最常見有hepatotoxicity, gastrointestinal intolerance, nongouty polyarthralgias, and asymptomatic hyperuricemia。
Hepatotoxicity: AST會升高,黃疸等,和劑量相關,當劑量小於25 mg/kg per day,肝毒性比較不會出現。但若之前有肝臟疾病,年齡大於60歲,並用INH, RMP會增加肝毒性風險。
剛才有說過PZA會代謝為Pyrazinoic acid,這個代謝物會和尿酸競爭排除,所以可能會出現無症狀的高尿酸血症,甚至在某些病人會惡化痛風。
腸胃道不適,會有噁心嘔吐等情況,皮膚可能會起疹子或光毒性,也可能有血小板低下等血液毒性。
所以要監測甚麼呢?病人基本的肝功能,uric acid。
mcg to mg 在 Maxine Chan Youtube 的最佳解答
hello my fellow fatties! HAHAH if you clicked into this video, you're probably looking to see what type of food/snacks you could order online sooo, we can be friends :')
FOLLOW ME:
INSTAGRAM: https://www.instagram.com/maxinechann/
SNAPCHAT: maxinechann
EMAIL: maxinechann@gmail.com
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Enjoy Life Foods, Chocolate Cinnamon Bites: https://hk.iherb.com/pr/Enjoy-Life-Foods-ProBurst-Bites-Chocolate-Cinnamon-Spice-6-4-oz-180-g/73589
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mcg to mg 在 Convert mcg to mg (Micrograms to Milligrams) - Pinterest 的推薦與評價
Apr 10, 2016 - Convert between micrograms mcg (μ) and milligrams (mg) with this conversion tool, data table and formula. ... <看更多>
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