高血壓 高尿酸 慢性腎病 胰島素 https://2019medicinenote.blogspot.com/2019/12/blog-post_57.html . 糖尿病相關筆記~目錄 https://2019medicinenote.blogspot.com/2020/01/blog-post_4.html

2024年5月29日 星期三

野外與登山醫學-其他高海拔疾病(扣除AMS HACE HAPE)

2024-05-28 17:29
剛剛想找高海拔頭痛的文章. 在uptodate裡面並沒有這個章節
(但WMS有)
但看到這段. 順便貼上來
(以下中文是google自動翻譯)
海拔相關的疾病— 非快速動眼睡眠期間呼吸改變,這種現象稱為海拔週期性呼吸,在海拔超過2500 m 時會遇到,並且在海拔更高的地方變得非常常見[17- 19]。它是潮式呼吸的一種形式,反映了睡眠期間由於缺氧(呼吸興奮劑)和低碳酸血症(呼吸抑制)導致的神經訊號變化。週期性的高原呼吸可能發生在海拔低至 1400 m 的地方,但通常不會幹擾睡眠,直到遊客或登山者達到海拔 2750 m 以上。 (請參閱「通氣控制障礙」) 當視網膜小動脈破裂導致血液外滲至視網膜時,就會發生高原視網膜出血[20-22]。視網膜循環發生許多與高原腦循環相同的變化。這種情況在海拔 5000 公尺(16,400 英尺)以上最常見,尤其是從事劇烈活動的人。除非出血延伸至黃斑,否則很少出現症狀。除 AMS/HACE 和 HAPE 之外,高海拔可能會導致或加劇許多疾病(表 4)。例子包括: 長期暴露在高原期造成的問題,例如慢性高山症和高原肺動脈高壓;因缺氧而加劇的原有疾病,如缺血性心臟病;以及在高海拔地區出現的與缺氧無關的病症,例如凍傷和光角膜炎。其中許多條件將單獨討論。 (請參閱「對希望搭飛機或前往高海拔地區的心臟病患者的處理」和「光角膜炎」和「凍傷:急性護理和預防」和「成人意外低溫」)
Other altitude-related illnesses — Altered breathing during non-REM sleep, a phenomenon known as periodic breathing of altitude, is encountered at altitudes over 2500 m and becomes very common at higher altitudes [17-19]. It is a form of Cheyne-Stokes respiration and reflects changes in neural signaling due to hypoxia (respiratory stimulant) and hypocapnia (respiratory depressant) during sleep. Periodic breathing of altitude may occur at altitudes as low as 1400 m but generally does not disrupt sleep until visitors or climbers reach altitudes above 2750 m. (See "Disorders of ventilatory control".) High altitude retinal hemorrhage occurs when there is rupture of retinal arterioles leading to extravasation of blood into the retina [20-22]. The retinal circulation develops many of the same changes seen in the cerebral circulation at altitude. It is most common at elevations above 5000 m (16,400 feet), particularly among those engaged in strenuous activity. Symptoms rarely develop unless hemorrhage extends to the macula. Numerous medical illnesses other than AMS/HACE and HAPE may be caused or exacerbated by high altitude (table 4). Examples include: problems resulting from chronic altitude exposure, such as chronic mountain sickness and high altitude pulmonary hypertension; preexisting medical conditions exacerbated by hypoxia, such as ischemic heart disease; and conditions arising at altitude unrelated to hypoxia, such as frostbite and photokeratitis. Many of these conditions are discussed separately. (See "Approach to patients with heart disease who wish to travel by air or to high altitude" and "Photokeratitis" and "Frostbite: Acute care and prevention" and "Accidental hypothermia in adults".)

2024年5月22日 星期三

傷口癒合與皮膚強度

2024-05-23 11:05AM
Wound Physiology Hailey Grubbs; Biagio Manna. Last Update: May 16, 2023.
以前的印象. 開放性傷口癒合之後, 經過三個月的皮膚強度可以恢復60-70% 
不過這篇寫的是 80%. 僅節錄其中一小段. 

Maturation
The final stage of wound healing is the maturation phase, and includes collagen cross-linking, remodeling, and wound contraction. Initially, fibroblasts synthesize type 3 collagen which is thinner than mature, type 1 collagen is abundantly found in healthy skin. During the maturation phase, type 1 collagen replaces the type 3 collagen found in granulation tissue, and a scar forms. This increase in type 1 collagen correlates with the increased strength of wounds seen 4 to 5 weeks after healing. A wound will regain 80% of its original strength 3 months after injury. Unfortunately, attaining the full strength of the skin before the injury is impossible. [3]

2024年5月20日 星期一

口罩政策 2024-05-20

 

  • 因應醫療(事)機構自本(113)年5月19日起調整為建議佩戴口罩場所,修訂COVID-19感染管制措施有關民眾與醫療照護工作人員佩戴口罩建議及因應作為,請貴院落實執行,請查照。

    • 依據衛生福利部疾病管制署(下稱疾管署)本年5月15日疾管感字第1130500238號函辦理。
    • 因應「為防治嚴重特殊傳染性肺炎,進入醫療(事)機構、老人福利機構應佩戴口罩」公告自本年5月19日停止適用,調整醫療(事)機構為建議佩戴口罩場所,修訂「醫療機構因應COVID-19感染管制措施指引」,自當日起調整COVID-19感染管制措施有關民眾與醫療照護工作人員佩戴口罩建議及因應作為,說明如下:
      • 宣導民眾佩戴口罩:
        • 宣導民眾進入醫療機構遵循呼吸道衛生與咳嗽禮節。佩戴口罩可防止呼吸道分泌物散播,惟如2歲以下嬰幼兒或因身體、心理等因素未能佩戴口罩者,於咳嗽或打噴嚏時,應使用衛生紙遮掩口鼻,使用完畢後將衛生紙丟進垃圾桶,並執行手部衛生,以降低病毒傳播風險。
        • 於醫療機構出入口、掛號櫃檯、急診、門診、住院區與網頁等有明確公告、廣播或志工主動關懷等方式,提醒民眾倘有疑似/感染呼吸道傳染病(如:流感、COVID-19)或出現發燒、呼吸道症狀(如:流鼻水、咳嗽或打噴嚏),非必要應避免進入醫療機構;如有必要進入,於有症狀期間及症狀緩解後5日內,進入醫療機構應佩戴口罩。另倘一週內曾與感染呼吸道傳染病者有密切接觸,進入醫療機構亦應佩戴口罩。
        • 醫療機構可依社區傳播風險評估(如:COVID-19疫情)與各單位實務現況(如:院內群聚事件、進入高風險單位),訂定應佩戴口罩之情境與區域管理措施。
      • 工作人員與個人防護裝備:
        • 工作人員應遵守標準防護措施,照護疑似或感染COVID-19病人應視其執行之醫療照護處置項目及場所,採取適當防護措施與個人防護裝備。並可視疫情風險或各單位實務需要考慮擴大使用呼吸道防護和護目裝備的時機。
        • COVID-19檢驗陽性之醫療照護工作人員返回工作後,仍應確實遵循呼吸道衛生及咳嗽禮節;於有症狀期間及症狀緩解後5日內,應於照護病人時全程佩戴醫用/外科口罩,並加強手部衛生。
      • 工程控制:
        • 室內倘因空間擁擠及換氣不足等,容易造成呼吸道傳染病傳播機率增加,透過採取相關工程控制機制(如:建立物理屏障及通風空間等),可降低醫療機構呼吸道傳播風險。
        • 醫療照護機構應有適當的空調通風系統,且應依循廠商建議定期清潔、檢查、維護保養或更換系統相關耗材配件等,確保醫療照護環境的有效通風,維護室內空氣品質。
    • 為建立民眾進入醫療機構配合佩戴口罩之新常態,疾管署製作「防範呼吸道傳染病,民眾進入醫療照護機構佩戴口罩須知」,請貴院可透過於出入口明顯處、大廳、掛號櫃臺或電梯等張貼,印製宣導單張,或透過廣播、跑馬燈、網頁或舉辦衛教講座等方式加強宣導。民眾於醫療機構建議應佩戴口罩的情境如下:
      • 有疑似/感染呼吸道傳染病(如:流感、COVID-19)或出現發燒、呼吸道症狀(如:流鼻水、咳嗽或打噴嚏)時,非必要請避免進入醫療機構;如有必要進入,於有症狀期間及症狀緩解後5日內,應佩戴口罩,並遵循呼吸道衛生與咳嗽禮節及落實手部衛生。
      • 過去一週內曾與感染呼吸道傳染病患者有密切接觸,進入醫療機構應佩戴口罩,並遵循呼吸道衛生與咳嗽禮節及落實手部衛生。
      • 本身為免疫力低下(如:移植或血液腫瘤等病人)或是具有其他流感、COVID-19重症高風險者,進入醫療機構應佩戴口罩並落實手部衛生。
      • 探視或照護疑似/感染呼吸道傳染病患者時,應佩戴口罩並落實手部衛生。
      • 當醫療機構依社區疫情及機構內傳播風險評估,規範應佩戴口罩之管理措施時,應依醫療機構規定佩戴口罩。
      • 當國家防疫政策或主管機關規定醫療機構應佩戴口罩之管理措施時,應依政策規定佩戴口罩。
    • 修訂之指引及增訂之須知請至疾管署全球資訊網/傳染病介紹/第四類法定傳染病/嚴重特殊傳染性肺炎/醫療照護機構感染管制相關指引項下下載。
    • 副本抄送相關公/協會,請轉知所屬會員配合落實執行防疫措施,降低疾病傳播風險。

2024年5月19日 星期日

登革熱的輸液治療

2024-05-20 08:55AM

登革熱靜脈輸液治療主要針對嚴重個案. 在謹慎的治療之下, 重症死亡率可降到 1% 以下. 但病患從一般狀況進展到重症. 不容易區分.
輸液原則, 針對重症病患. 給予最少的點滴. 維持正常的生理循環所需(可監測尿量. 維持每小時每公斤 0.5cc 小便)

需注意一些警示徵象. 每 1-4 小時測量病患生命徵象. 每 4-6 小時紀錄尿量. 


通常打點滴的時間大約 24-48 小時, 當重症患者病情逐漸改善. 需減少輸液量. 避免過度輸液. 當血漿滲漏出的體液回到血管內. 若是過度輸液可能造成肺水腫. 心衰竭.
WHO版本 DHF guideline
A joint publication of the World Health Organization (WHO) and the Special Programme for Research and Training in Tropical Diseases (TDR) 21 April 2009
| Technical document

(22/160) <= 這是pdf檔案的頁數. 不是文章的頁數
1.1.6 Dengue case classification Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting non-severe clinical course, a small proportion progress to severe disease, mostly characterized by plasma leakage with or without haemorrhage. Intravenous rehydration is the therapy of choice; this intervention can reduce the case fatality rate to less than 1% of severe cases. The group progressing from non-severe to severe disease is difficult to define, but this is an important concern since appropriate treatment may prevent these patients from developing more severe clinical conditions.

(25/160)
Children are at a higher risk of severe dengue (39). Intensive care is required for severely ill patients, including intravenous fluids, blood or plasma transfusion and medicines.

(39/160)
Those who deteriorate will manifest with warning signs. This is called dengue with warning signs (Textbox C). Cases of dengue with warning signs will probably recover with early intravenous rehydration. Some cases will deteriorate to severe dengue (see below).
Respiratory distress from massive pleural effusion and ascites will occur at any time if excessive intravenous fluids have been administered. During the critical and/or recovery phases, excessive fluid therapy is associated with pulmonary oedema or congestive heart failure.


47/160
Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient.
• Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated).
台灣疾病管制署-登革熱臨床症狀‧診斷與治療(第六版) 2015年5月出版








2024年5月14日 星期二

野外與登山醫學- 剛剛遇到一個學校老師來幫小朋友開丹木斯

2024-05-14 15:40

剛剛看門診時, 有位老師來衛生所想開預防高山症的藥物(正確一點的說法是預防AMS急性高山病). 聽說學校要辦爬山活動. 我稍微打了幾行字. 請老師給家長看. 


關於高海拔疾病

兒童通常不建議使用藥物作為預防方式.

藥物可使用 Acetazolamide

以到達海拔 2500 公尺的時間作為預設時間點. 在這個時間往回推24 小時開始服藥. 每天兩次.

當睡眠海拔開始下降即可停用藥物

劑量; 每次每公斤 2.5mg (Acetazolamide劑量通常是一顆250mg)

20公斤重小孩每次 50mg

40公斤重小孩每次 100mg.

50公斤重以及以上的. 比照成人劑量.

成人每次 125mg. 每天兩次.

參考資料: uptodate

Acetazolamide: Pediatric drug information

https://pro.uptodatefree.ir/Show/13213

Prevention: Limited data available: Infants, Children, and Adolescents: Oral: Immediate release: 2.5 mg/kg/dose every 12 hours started either the day before (preferred) or on the day of ascent and may be discontinued after staying at the same elevation for 2 to 3 days or if descent initiated; maximum dose: 125 mg/dose (Ref). Note: The International Society for Mountain Medicine does not recommend prophylaxis in children except in the rare circumstance of unavoidable rapid ascent or in children with known previous susceptibility to acute mountain sickness (Ref). Higher doses are effective up to 500 mg, but are also associated with increased adverse effects and not recommended 

 

2024年5月9日 星期四

成人缺鐵性貧血治療 from uptodate

2024-05-10 09:50AM.
1. IDA患者. 依照 ferritin 數值決定是否需補充鐵劑
2. IDA患者沒有貧血. 但ferritin 低於正常值, 建議補充鐵劑

剛剛看一個IDA患者. 病患詢問是否需補充鐵劑.
目前血色素還好 11.5 但元素鐵確實不足 24 且 TIBC 上升.
uptodate上面建議. 有缺鐵但沒有貧血. 還是建議補充鐵劑.
但IDA患者如果貧血及缺鐵狀況改善. 就不用補充鐵劑



臨床筆記有一篇IDA的文章 缺鐵性貧血. 裡面有一段
此外在口服鐵劑治療中的病人,血清Ferritin之追蹤可用來監測鐵儲存是否回升正常,可供決定何時停藥。


查詢uptodate上面的IDA治療篇. 缺鐵但是血色素正常個案. 仍可補充鐵劑
先將 uptodate上面的總結放上來. 
(下面中文是用 google 翻譯)
總結和建議
●治療對象-無論是否有症狀,所有缺鐵性貧血患者和大多數缺鐵但無貧血的患者都應接受治療。也必須找出並解決缺鐵的原因,特別是對於新發缺鐵的成年人。健康的飲食可以提供足夠的鐵來滿足生理需要,但不能糾正鐵缺乏症。
●紅血球輸注的作用– 患有嚴重、嚴重症狀(例如,有心肌缺血症狀)或危及生命的貧血的患者應接受紅血球(RBC)輸注治療(流程圖 1)。
●口服鐵劑與靜脈注射鐵劑-某些情況可能會影響鐵劑的劑量和/或給藥途徑(口服與靜脈注射[IV])(表 2)。由於給藥方便,我們通常口服鐵劑治療無併發症的缺鐵性貧血患者,如演算法(演算法 1)所示。然而,具有改善毒性特徵的靜脈鐵劑製劑的出現降低了許多患者選擇靜脈製劑的門檻。在治療孕婦以及患有發炎性腸道疾病、胃手術或慢性腎臟病的患者時,我們經常使用靜脈注射鐵劑。
•劑量和配方(口服鐵劑) ——在大多數情況下,所有口服鐵劑製劑都同樣有效(表 4)。接受口服鐵劑治療的個人可以選擇每隔一天(或週一、週三和週五)服用一顆藥片或每天服用一顆藥片。這兩個方案的功效看起來相似;每日給藥時胃腸道副作用較常見。上面列出了提高耐受性的策略。
•劑量和配方(靜脈鐵劑) ——在許多情況下,靜脈注射可能優於口服給藥,包括持續失血、幹擾口服吸收或鐵穩態的生理或解剖異常,以及口服鐵劑無法耐受的胃腸道副作用。有多種 IV 鐵製劑可供選擇(表 3);它們的劑量和給藥方法如上所述。
●口服鐵劑的不良反應-口服鐵劑的胃腸道副作用極為常見。減少這些影響的策略包括將頻率減少到每隔一天一次(如果尚未這樣做)、調整飲食以及改用液體配方。
●靜脈鐵劑的副作用-由於擔心過敏反應,許多臨床醫生不願意使用靜脈鐵劑。我們認為,真正的過敏反應極為罕見,而且被嚴重高估,這主要是由於使用舊產品(例如已不再使用的高分子量右旋糖酐鐵(HMW ID))的經驗,以及使用苯海拉明積極治療非過敏性輸注反應的做法以及其他將反應轉變為更嚴重事件的療法。我們在靜脈鐵劑治療前不使用常規術前用藥,並且避免使用苯海拉明。對於患有氣喘、發炎性風濕性疾病或多種藥物過敏的個體,我們通常將術前用藥限制為單獨使用糖皮質激素。
●預期反應– 缺鐵的有效治療可緩解症狀、出現適度的網狀紅血球增多(7 至 10 天內達到高峰),並在 6 至 8 週內使血紅素水平恢復正常。缺乏反應的原因包括不堅持口服鐵劑、持續失血、初步診斷不正確或有其他診斷(表 10)。其中一些額外的診斷,例如乳糜瀉,可能對評估特別重要。

●Whom to treat – Regardless of the presence of symptoms, all patients with iron deficiency anemia and most patients with iron deficiency without anemia should be treated. The cause of iron deficiency also must be identified and addressed, especially in adults with new onset iron deficiency. A healthy diet provides sufficient iron for physiologic needs but cannot correct iron deficiency. (See 'Initial considerations' above.)



●Role of RBC transfusion – Patients with severe, severely symptomatic (eg, with symptoms of myocardial ischemia), or life-threatening anemia should be treated with red blood cell (RBC) transfusion (algorithm 1). (See 'Severe/life-threatening anemia' above.)



●Oral versus IV iron – Some conditions may affect iron dosing and/or the route of administration (oral versus intravenous [IV]) (table 2). We generally treat patients who have uncomplicated iron deficiency anemia with oral iron due to the ease of administration, as illustrated in the algorithm (algorithm 1). However, the availability of IV iron formulations with improved toxicity profiles has lowered the threshold at which many patients would prefer an IV preparation. We often use IV iron when treating pregnant individuals and individuals with inflammatory bowel disease, gastric surgery, or chronic kidney disease. (See 'Oral versus IV iron' above and "Anemia in pregnancy" and 'Older adults' above and 'Inflammatory bowel disease and iron-restricted erythropoiesis' above and 'Following gastrointestinal/bariatric surgery' above and 'Perioperative' above and 'Chronic kidney disease' above and 'Heart failure' above and 'H. pylori, peptic ulcer disease, and gastritis' above.)



•Dose and formulation (oral iron) – For the most part, all oral iron preparations are equally effective (table 4). Individuals treated with oral iron can choose between taking one tablet every other day (or on Monday, Wednesday, and Friday) or one tablet per day. Efficacy between these two schedules appears similar; gastrointestinal side effects are more common with daily dosing. Strategies to improve tolerability are listed above. (See 'Oral iron' above.)



•Dose and formulation (IV iron) – There are a number of settings in which IV may be preferable to oral administration, including ongoing blood loss, physiologic or anatomic abnormality that interferes with oral absorption or iron homeostasis, and intolerable gastrointestinal side effects of oral iron. A number of IV iron formulations are available (table 3); their dosing and administration are described above. (See 'Choice of IV formulation' above and 'Dosing/administration of specific IV iron preparations' above.)



●Adverse effects of oral iron – Gastrointestinal side effects are extremely common with oral iron administration. Strategies to reduce these effects include reducing the frequency to every other day if not done already, dietary modifications, and switching to a liquid formulation. (See 'Side effects (oral iron)' above and 'Strategies to improve tolerability' above.)



●Adverse effects of IV iron – Many clinicians are reluctant to use IV iron due to concerns about anaphylaxis. We believe true allergic reactions are exceedingly rare and vastly overestimated, largely due to experience with older products such as high molecular weight iron dextran (HMW ID), which is no longer used, and the practice of aggressively treating non-allergic infusion reactions with diphenhydramine and other therapies that convert the reaction to a more serious event. We do not use routine premedication prior to IV iron and we avoid diphenhydramine. For individuals with asthma, inflammatory rheumatic conditions, or multiple drug allergies, we generally limit premedication to a glucocorticoid alone. (See 'Allergic and infusion reactions' above.)



●Expected response – Effective treatment of iron deficiency results in resolution of symptoms, a modest reticulocytosis (peaking in 7 to 10 days), and normalization of the hemoglobin level in six to eight weeks. Causes for a lack of response include nonadherence to oral iron, ongoing blood loss, and incorrect initial diagnosis or the presence of additional diagnoses (table 10). Some of these additional diagnoses, such as celiac disease, may be especially important to evaluate. (See 'Response to iron supplementation' above.)

幾項小型試驗和觀察性研究已經證明了補充鐵劑對治療缺鐵相關疲勞但不伴隨貧血的益處:
●一項試驗隨機分配90 名患有疲勞、血清鐵蛋白≤50 ng/mL、血紅素≥12.0 g/dL 的非貧血停經前女性,在兩週內接受累積劑量為800 mg 的靜脈注射(IV) 鐵劑或安慰劑 [ 2 ] 。治療開始六週後,靜脈鐵劑治療組的疲勞狀況得到改善(兩組的基線分別為 4.5 和 10 分制,分別為 1.1 和 0.7)。對於基線血清鐵蛋白≤15 ng/mL 的患者,效果更為明顯。補充鐵劑的益處持續到 12 週。 IV 鐵劑組的不良事件較多(21% 對 9%),但均不嚴重。如預期的那樣,靜脈鐵劑組鐵蛋白增加(平均增加 98 ng/mL),而安慰劑組則沒有。觀察性研究也報告,接受靜脈鐵劑治療的鐵蛋白水平較低的非貧血停經前女性的症狀有所改善 [ 3 ]。
●三項試驗將鐵蛋白水平較低的非貧血女性隨機分組,分別接受口服鐵補充劑(通常每天 80 毫克元素鐵)與安慰劑或高鐵飲食,所有試驗均報告口服鐵可改善疲勞情況 [ 4- 6 ]。使用膳食鐵作為比較的試驗也發現飲食鐵有改善,但補充劑組中鐵蛋白的平均增加幅度較大 [ 4 ]。
●對跑步者和捐血者的其他試驗表明,補充鐵可以改善運動表現、睡眠障礙和指甲斷裂 [ 7-9 ]。
這些數據支持了上述建議,即缺鐵但不貧血的人應該補充鐵。尋找失血或鐵流失來源的重要性也適用於這些人。 (參見下文『缺乏/失血的來源』 )
不建議對沒有缺鐵的個體進行常規補鐵。在極少數情況下,如果所有其他幹預措施都已用盡,一些專家會在沒有明顯實驗室證據表明鐵儲存減少的情況下,治療患有缺鐵症狀(嗜冰癖或不寧腿綜合症)的患者。The benefit of iron replacement for iron deficiency-associated fatigue without anemia has been demonstrated in several small trials and observational studies:

●A trial randomly assigned 90 non-anemic premenopausal females with fatigue, serum ferritin ≤50 ng/mL, and hemoglobin ≥12.0 g/dL to receive a cumulative dose of 800 mg of intravenous (IV) iron or placebo over two weeks [2]. Six weeks after treatment initiation, fatigue was improved in the IV iron arm (decrease of 1.1 versus 0.7 on a 10-point scale, from a baseline of 4.5 in both groups). The effect was more pronounced in those with a baseline serum ferritin ≤15 ng/mL. Benefits of iron supplementation persisted at 12 weeks. Adverse events were greater in the IV iron group (21 versus 9 percent), but none were considered serious. As expected, the IV iron group had increased ferritin (mean increase, 98 ng/mL) and the placebo group did not. Observational studies have also reported improvement in symptoms in non-anemic premenopausal females with low ferritin who were treated with IV iron [3].

●Three trials, which randomly assigned groups of nonanemic females with low ferritin to oral iron supplementation (typically 80 mg of elemental iron daily) versus placebo or a high-iron diet, all reported improvement in fatigue with oral iron [4-6]. The trial that used dietary iron as a comparator also found improvement with dietary iron, but mean increases in ferritin were greater in the supplement group [4].

●Additional trials in runners and blood donors have demonstrated that iron repletion can improve athletic performance, sleep disturbance, and fingernail breakage [7-9].

These data are supportive of the above recommendation that iron should be repleted in those with iron deficiency without anemia. The importance of finding the source of blood loss or iron loss also applies in these individuals.

(下面中文是用 google 翻譯)
此演算法適用於缺鐵的個體,無論是否患有貧血。我們治療所有缺鐵性貧血患者和大多數缺鐵但不貧血的患者。對於口服鐵劑,隔日給藥可促進吸收並減少不良反應;然而,如果願意,有些患者可以合理地每天服用劑量,而不是每隔一天服用一次。
This algorithm applies to individuals with iron deficiency, with or without anemia. We treat all individuals who have iron deficiency anemia and most who have iron deficiency without anemia. For oral iron, alternate-day dosing facilitates absorption and reduces adverse effects; however, some patients may reasonably take their dose daily rather than every other day if preferred. Refer to UpToDate for efficacy and adverse effects of different oral and intravenous iron formulations and supporting evidence. There is a separate algorithm in UpToDate for managing iron deficiency in pregnancy.




對於缺鐵但沒有貧血. 仍建議治療. 但治療一段時間之後可測量 ferritin 是否正常.

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