Nephrology and Urology
Erythropoietin (EPO) dosing in anemia of CKD
Erythropoiesis-stimulating agents (ESAs) like erythropoietin (EPO) are integral for managing anemia in chronic kidney disease (CKD) . The recommended initial EPO dosing varies based on the route of administration and the patient’s clinical situation. For subcutaneous (SC) administration, start with a dose ranging from 50 to 100 U/…
قراءة المزيد
Pediatric
Ensure babies and kids get enough iron
As a nutrition support pharmacist, you are on the front lines to help prevent iron deficiency in kids under 2 years. Iron deficiency in young kids can impair motor and neurological development and may lead to anemia. It's common in low-income areas due to poor nutritional intake. But consider other risk factors for iron deficiency , such as preterm birth, born …
قراءة المزيد
Vitamin-B12 Deficiency
Best approach for treating megaloblastic anemia
BACKGROUND ㅡ Megaloblastic anemia is characterized by red blood cells (RBCs) that are larger than normal and caused by B12 or folic acid deficiency, drugs, or genetic disorders. In certain populations such as patients from India, B12 deficiency is higher (> 75%), probably due to the largely vegetarian diet. Patients with meglobastic anemia can have higher homocys…
قراءة المزيد
Nutrition
Clarify limitations of alternate-day oral iron dosing
Is it better to take oral iron supplements every other day? ㅡ Not really. Some recent evidence suggests giving doses every OTHER day increases the amount of oral iron absorbed by up to 50%. Unabsorbed iron is thought to be the culprit for GI side effects. It's no surprise that DIVIDING the daily iron dose every other day seems to …
قراءة المزيد
Vitamin-B12 Deficiency
Consider more use of INTRAVENOUS iron to patients
As a pharmacist, you'll see expanded use of IV iron in medical patients. More experts are advocating for IV iron replacement beyond patients with chronic kidney disease (CKD). This is due to faster repletion, poor tolerability of oral iron and low adverse event risk. A typical dose in a non-CKD patient is 1,000 mg over one hour. We know to consider IV iron when o…
قراءة المزيد
Iron Therapy
Using IV iron may improve heart failure symptoms
As a clinical pharmacist, you'll hear about using IV iron to improve heart failure symptoms. This is very preliminary, but could be important if it pans out. Up to 20% of heart failure patients are iron deficient which can lead to fatigue and exercise intolerance. Now evidence shows that treating iron deficiency can help patients …
قراءة المزيد
Iron Therapy
Recommend ferrous sulfate or ferrous fumarate when oral iron is needed
It's tricky to iron out differences among ORAL IRON supplements. Efficacy and tolerability are similar at equal doses of ELEMENTAL iron. But the percent of elemental iron varies between products. iron deficiency , start with 100 to 200 mg/day elemental iron in most cases. Use ferrous sulfate or fumarate, they often have 65 to 100 mg elemental iron/tab ve…
قراءة المزيد
Vitamin-B12 Deficiency
Iron deficiency anemia (IDA)
O verview ― Iron deficiency is present if serum ferritin is < 12 ng/mL or < 30 ng/mL if also anemic. In adults, caused by bleeding unless proved otherwise. Causes include blood loss (gastrointestinal, menstrual, repeated blood donation), deficient diet or decreased absorption of iron and increased requirements (pregnancy, lactation). Women with heavy menstrual…
قراءة المزيد
Vitamin-B12 Deficiency
Overview of anemia
Screening ― Do not perform routine screening for anemia in nonpregnant, asymptomatic patients. Although determination of hemoglobin concentration or hematocrit is important to evaluating a variety of complaints (e.g., fatigue, weight loss, abdominal pain, GI bleeding) and may provide clues in asymptomatic patients to presence of treatable disease (e.g., GI malignancy…
قراءة المزيد
Vitamin-B12 Deficiency
Management of vitamin B12 deficiency
Overview ㅡ Vitamin B12 ( cobalamin ) is necessary for a variety of critical functions within the human body (e.g., blood cell production, DNA synthesis, and neurologic function). Dietary sources of cobalamin are mainly found in animal products and fortified foods (e.g., Cereal). Vitamin B12 deficiency is a common problem, especially in the elderly. It is one of the …
قراءة المزيد
Social Plugin