_gluconate 用于小儿肠炎课件

門 診 處 方 討 論 Zinc gluconate 用於小兒腸炎 報告日期：99.1.28 曾淑美 藥師 Outline 小兒腹瀉的類型？ 小兒腹瀉臨床表徵？ 小兒腹瀉的治療？ Zinc的生理功能？ Zinc用於腹瀉的機轉？ Zinc用於治療腹瀉的劑量是否合理？ 證據等級？ Zinc的注意事項？ 結論 小兒腹瀉類型 Reference:World Gastroenterology Organisation practice guideline Causative agents and pathogenic mechanisms Reference:World Gastroenterology Organisation practice guideline World Gastroenterology Organisation practice guidelineReference: 小兒腹瀉臨床表徵 Reference: World Gastroenterology Organisation practice guideline 小兒腹瀉的治療 藥物治療 非藥物治療 藥物治療 -本院有的藥品品項 Adsorbents Kaolin-pectin Adult：60 to 120 mL /day Children： (3 to 6 y) 15 to 30 ml/day (6 to 12 y) 30 to 60 ml/day (12 y and over) 45 to 60 ml/day Antimotility agents （Opiate derivatives ） Loperamide（Imodin） Adult ：4 mg ORALLY followed by 2 mg after each loose stool up to a maximum of 16mg/day Children ：(2 to 5 y, 13 to 20 kg) 1 mg ORALLY 3 times daily (6 to 8 y, 20 to 30 kg) 2 mg ORALLY twice daily (8 to 12 y, greater than 30 kg) 2 mg ORALLY 3 times daily Reference: micromedex Toxin binders cholestyramine（Questran ） Adults: 4g qd-bid AC (3):CD005436. Review. For all children with diarrhea: 20 mg zinc for 14 days.(developing countries ) Reference: World Gastroenterology Organisation practice guideline 證據（1） FDA Approval: Adult, no; Pediatric, no Efficacy: Pediatric, Evidence favors efficacy Recommendation: Pediatric, Class IIb Strength of Evidence: Pediatric, Category B Reference: micromedex 證據（1） 收錄對象： 3-24個月的小孩 鋅治療的期限：14天 鋅的劑量：20 mg/day 實驗結果：有補充鋅的實驗組在腹瀉糞便產量降低28、 腹瀉持續時間縮短為14。 結論: 補充鋅可以減少營養不良兒童腹瀉的發生率和持續時間 Reference: micromedex 證據（2） Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. 收錄對象： The review of trials identified 18 trials involving 6165 children of all ages. Children aged between one month and five years with acute or persistent diarrhoea, including dysentery. Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. 證據（2） used zinc 5 mg20 mg/day. two trials administered higher zinc doses: 40 mg/day Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. Zinc 用於腹瀉的劑量 In areas where diarrhoea is an important cause of child mortality, research evidence shows zinc is clearly of benefit in children aged six months or more. Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. Summary 病患的衛教 飲食方面的控制治療 1、先暫停飲食，到流質、半流質、稀飯、軟食，一步 一步的給予。 2、選擇的食物應要纖維少及容易消化。 3、儘量少服用以下食物：茄子，菠菜，菇類，碳酸飲 料及螃蟹、烏賊等生的魚類，以免刺激腸道或 增加病菌 感染的可能性。 輸液治療 補充水份及電解質，避免其他嚴重狀況如脫水等情形發 生。 其他：保持身體的清潔，肛門部份的清理，予以溫和坐 浴及保持肛門周圍的乾燥。 注意事項 Zinc的副作用 Zinc can cause vomiting because of its metallic taste. In high doses, zinc can also cause epigastric pain, lethargy and fatigue. Zn過量後果： 大量鋅會引發噁心、嘔吐、發燒、血液中高密度脂蛋白 減少，進而提高心血管疾病發生機率。 結論 Diarrhoea causes around two million child deaths annually. Zinc supplementation could help reduce the duration and severity of diarrhoea, and is recommended by the World Health Organization and UNICEF. Reference: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. Review. 醫師處方分別開立於98/07/11和98/07/18，給 予zinc gluconate 10 mg 0.5 tab bid 治療期 間各為7天，是屬於合理，然後衛生署所核准的 適應症為鋅不足的補充，病患沒有驗鋅的濃度， 不知是否缺鋅，所以不符合健保規範，故病患 須以自費的方式 結論 The end Zinc 臨床用途 ZincZinc deficiency 25 to 50 mg elemental zinc ORALLY per day Zinc deficiency; Prophylaxis 25 to 50 mg elemental zinc ORALLY per day Wilsons disease（zinc acetate） 1) adult 50 mg ORALLY 3 times a day (Prod Info GALZIN(TM) oral capsules, 2002) 2) Pediatric (10 y and older) 25 mg ORALLY 3 times a day; may be increased to 50 mg ORALLY 3 times a day as needed (Prod Info GALZIN(TM) oral capsules, 2