~A Boy Always Young~

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2011年9月21日 星期三

Nutrition





基本營養:
30-35ml/kg (geriatrics 30 ml/kg), 1ml/kcal fed, 1500ml/m2 TBSA


Calories
1.Maintenance: 25-30kcal/kg actual wt unless obese
2.Hypercatabolic: 25-35 kcal/kg actual wt unless obese
3.Obesity: calculate needs using Adjusted Body Weight (AW) – 21-25 kcal/kg adjusted BW


***AW=IBW+{(actual wt-IBW)x.25}***


Protein
1.Maintenance: 1.0-1.2 gms/kg/IBW
2.Moderate stress: 1.2-1.5 gms/kg/IBW
3.Severe stress: 1.5-2.0 gms/kg/IBW
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2011年8月15日 星期一

IVF



晶體溶液
等滲透壓,血管內:細胞間質=1:3,會使血管容積稍微增加一些。
Hartmann`s solution和0.9%的NCl
Hartmann`s solution中的乳酸鹽在肝臟中會氧化,會糖質新生。代謝路徑會消耗氫離子,所以會輕微鹼化。

膠體溶液
含有懸浮大分子的溶液,產生膠體滲透壓,使溶液留在血管裡
緩衝凝膠【Haemaccel (polygeline) and Gelofusine (succinylated gelatin)】、hydroxyethyl starch
Haemaccel含有鈣,如果血液含有檸檬酸鹽,會有凝集現象
網狀內皮系統在血液中藉由吞噬作用將hydroxyethyl starch吞噬進來,排出的時間會延長,MAX 20ml/kg/day

先輸1-2升的晶體溶液(Hartmann's solution或0.9%的氯化鈉溶液)
再輸1-2升的膠体溶液。非必要不要輸葡萄糖溶液。
有失血則輸血。
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2011年7月27日 星期三

Gas


CO2↑10 → HCO3-↑1:Acute respiratory acidosis
CO2↓10 → HCO3-↓2:Acute respiratory alkaldosis
CO2↑10 → HCO3-↑4:Chronic respiratory acidosis
CO2↓10 → HCO3-↓5:Chronic respiratory alkaldosis




HCO3-↓10 → CO2↓10~13:Metabolic acidosis
HCO3-↑10 → CO2↑6        :Metabolic alkaldosis
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2011年7月14日 星期四

Review of Systems


l   General: body weight change, weakness, fatigue, fever, chills
l   Skin: rashes, lumps, sores, itching, dryness, color change, change in hair or nails
l   Head: headache, head injury
l   Eye: vision, glasses or contact lenses, pain, redness, excessive tearing, double vision, glaucoma cataracts
l   Nose and sinuses: frequent colds, nasal stuffiness, discharge, itching hay fever, nose bleeds, sinus trouble
l   Neck: lumps in the neck, swollen glands, goiter, pain or stiffness
l   Breast: lumps, pain or discomfort, nipple discharge, self-exam
l   Cardiovascular: chest pain, high blood pressure, rheumatic fever, heart murmurs, orthopnea, paroxysmal nocturnal dyspnea, edema
l   Respiratory system: cough, sputum, hemoptysis, wheezing, asthma, bronchitis, ephysema, pneumonia, Tuberculosis, pleurisy
l   Endocrine: thyroid trouble, heart or cold intolerance, excessive sweating, diabetes, excessive thirst or hunger, polyuria
l   Hematologic: anemia, ease bruising or bleeding, post transfusions, possible reaction
l   Lympahtic: lymphadenopathy:  location:    size:      character:
l   Gastrointestinal: trouble swallowing , heat burn , appetite , nausea , vomiting , regurgitation , vomiting of blood , indigestion ,  color and size of stools , change in bowel habits , rectal bleeding or a tarry stools , hemorrhoids , constipation , diarrhea , abdominal pain , food intolerance , hepatitis , jaundice , liver or gallbladder disease , excessive belching or passing of gas
l   Genitourinary: frequent of urination , polyuria , nocturia , burning or pain on urination , hematuria , urgency , reduced caliber or force of the urinary stream , hesitancy , incontinence , urinary infection , stones
l   Musculoskeletal: muscle or joint pain , stiffness , arthritis , gout , backache
l   Rheumatologic: hair loss , malar rash , discoid rash , oral ulcer , athralgia , dry eye , dry mouth
l   Neurologic: consciousness change , fainting , blackouts , seizures , weakness , paralysis . numbness , tingling , tremors or other involuntary movements.
l   Psychiatric: nervousness , tension , mood change including depression , memory loss , auditory hallucination , visual hallucination , involuntary movement
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2011年7月12日 星期二

IVF


甲、Holliday-Segar method
l   10kgà100ml10-20kgà50ml>20kgà20ml
乙、正常所需:
l   Na+75-175mEq/day (2 meq/kg/day)
l   K+20-60mEq/day ( 1 meq/kg/day)
--1amp=15% 5cc
,約需2-6amp
--
口服U-citrate Granules內含Potassium Citrate 30mEq/PKG--一顆Slow-K8 mEq
l   Detrose 100-150g/day (低血糖可用250g/day)
l   NPO:每天給D5W 1000cc+ 1/2Saline 1500cc,每袋各加KCL 1amp
l   速記:2000 cc Na120 meqK60 meqGlu100~150 g微血管可承受600 mosm
丙、略估輸液速度
l   15 = 1cc1/sà4cc/minà240cc/hr(大人)
l   60 = 1cc1/sà1cc/minà60cc/hr(小孩)
丁、常見輸液濃度

Osmo (mosm)
 Glu (g/L)
 Na (Cl) (meq/L)
 K (meq/L)
 D5W
 278
 50
 0
 0
 D10W
 278 X2
 50 X2
 0
 0
 D50W
 278 X10
 50 X10
 0
 0 


 Osmo (mosm)
Glu (g/L) 
Na (Cl) (meq/L)
 K (meq/L)
 N/S (0.9%)
 308
 0 
 154
 0
 1/2 N/S
 308 X1/2
 0
 154 X1/2
 0
 1/4 N/S
 308 X1/4
 0
 154 X1/4
 0
 3% N/S
 308 X 3
 0
 154 X3
 0


Osmo (mosm)
 Glu (g/L)
 Na (Cl) (meq/L)
 K (meq/L)
 D5S
 278+308=586
 50
 154
 0
 D5S1/2
 278+308X1/2=355
 50
 154X1/2=76
 0
 D5S1/4
 278+308X1/4=431
 50
 154X1/4=38
 0 


 Osmo (mosm)
 Glu (g/L)
 Na (Cl) (meq/L)
 K (meq/L)
 HCO3- (meq/L)
 L-R
 273 
 50
 130
 4
 28

    戊、常用的PPN熱量表

D5W 500ml
85 kcal
Amino-V 500ml
200 kcal
Aminoplasma 500ml
400 kcal
10% Intrafat 200ml
220 kcal
10% Intralipid 100ml
110 kcal
20% Lipovenous 250ml
500 kcal
20% Lipofundin 250ml
500 kcal
10% Glycerol 300ml
190 kcal
20% Mannitol 500ml
200 kcal


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