Nutrition/Naturals

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Cation-Exchange Resins

sodium polystyrene sulfonate=Kayexalate: AVL: PO, rectal. IND: Hyperkalemia. ADM: Mixed in water (avoid K containing juices). AE: Hypokalemia, fecal impaction (high dose). CI: K1+<5, obstructive bowel disease. DI: sorbitol. PK: F=0 DOS: 15-60g (30g typical) OTH: Can bind 3.1mM of K1+ for every gram of kayexalate. 1 mol of Na released for every mol of K. Can also bind Ca, Li and Mg. Most action in Large intestine.

 

CoEnzymes

CoEnzyme Q10: IND: Replaces enzyme lost w/ statin use, HF (possibly effective), HTN (possibly effective).

 

Diets

DASH diet=Dietary Approach to Stop Hypertension: EVD: Many trials have shown that it reduces BP (~5/3) for various pts w/ HTN or preHTN. OTH: Emphasizes foods high in: protein, fiber, K, Mg, and Ca (ex fruits, vegetables, nuts, beans, whole grain, low-fat dairy). Limit sugar and saturated fats. Doesn’t talk about Na. <1% of Americans conform to the DASH diet.
ketogenic diet:

 

Echinacea

Echinacea: AVL: Tablets, tinctures, fluid extracts, juices. DOS: Dried root equivalent: E angustifolia=1-3g/d. E purpurea=0.9-4.5g/d. E pallida=0.36-3g/d. OTH: Echinacea is a genus of plant that has a few different species used (ex. E. angustifolia, E. purpurea, E. pallida).

 

Elements - Iron (Fe2+)

iron isomaltoside=Monoferric: AVL: IV (100mg elemental/mL in 1mL, 5mL and 10mL single-dose vials). IND: Iron deficiency in adults intolerant or unresponsive to oral iron. ADM: Administered as IV bolus, IV infusion or as direct injection into venous limb of a dialyzer during hemodialysis. MON: Monitor for hypersensitivity rxns during and at least 30min following each dose. DOS: Individualized for pts hemoglobin target level and iron stores.
iron (general)=ferrous sulphate, Feramax: AVL: PO (tab: ferous sulphate=300mg (60mg elemental), liquid). MOA: Body uses Fe in Hgb to transport O2. EVD: XR ferrous sulphate preparations are ineffective and expensive. ADM: T without food for better F. AE: Naus, dyspepsia, const, diar, dark stools. Liquid preparations can stain teeth. DOS: Start at low dose. OTH: Foods rich in heme iron: clams, liver, pork, chicken, beef. Foods rich in non-heme iron: enriched oatmeal, pumpkin seeds, molasses, lentils, kidney beans. Eating foods w/ Vit C like cantaloupe, honey duw, grapefruit etc w/ non-heme iron containing foods increases the F.

 

Elements - Other

calcium (Ca2+): PRG: RDA=1000mg. LAC: RDA=1000mg. DOS: RDA=1000-1200 mg. TUL=2500mg/d.


potassium (K1+): OTH: Foods high in K: avocado, bananas, beans, bran, cantaloupe, carrots, chocolate, figs, nuts, juices (carrot, grapefruit, orange, prune & vegetable), milk, raisins, potatoes, pumpkins, salt substitutes, spinach, tomatoes & yogurt.
sodium (Na1+): DOS: FDA recommends <2.3g/d. WHO <2g/d. AHA <1.5g/d.
zinc (Zn2+): PRG: RDA when pregnant=11mg. LAC: RDA when lactating=12mg. DOS: RDA=8-12 mg. TUL=40mg/d.


 

Garlic

Garlic: EVD: Ineffective for hyperlipidemia. Possibly effective for HTN.

 

Ginseng:

Ginseng: OTH: Cold Fx=North American Ginseng.

 

Omega-3 Fatty Acids:

IND: hypertriglyceridemia. MOA: EPA and DHA are the active ingredients. EVD: Increases HDL 5-10%. decreases TG 25-30%. AE: Naus, GI upset, fishy burbs, bleed riskwhen dose >3g/d. DI: Antithrombotics or anticoagulants can increase bleeds. DOS: 2-4g/d. OTH: Sources: fatty fish, krill oil, microalgae oil, marine lipid concentrate, phytoplankton.
Fish Oil: EVD: Effective at reducing Triglyceride levels 20-50%.


 

Other

grapefruit juice: DI: Will increase levels of amiodarone, cyclosporine, erythromycin, felodipine, lovastatin, nifedipine. PK: Non-reversible inhibitor of the intestinal enzyme CYP 3A4.


hawthorn: IND: Traditionally used for HF, angina, HTN, arrhythmias. EVD: Safe and possibly effective for mild forms of HF.


nicotinic acid/niacin=Niaspan: IND: Hyperlipidemia (lacks evidence). MOA: Inhibits liver VLDL synthesis and secretion. EVD: decreases LDL 5-25%, increases HDL 15-35%, decreases TG 20-50%. ADM: T w/ food. AE: Naus, Diar, skin flushing, hyperglycemia, gout, liver toxicity, increased ALT 1%. CI: Gout, peptic ulcer, and liver disease. DOS: IR: Start 50-100mg bid. Double every 3-7d up to 1.5g bid. Max 4.5 g/d. ER: Start 0.5g hs titrate up 0.5g/d each every w to 2 g/d. Max 3g/d).


Saint John’s Wort: DI: COCs, antiretrovirals, antiepileptics, CCBs, cyclosporine, fentanyl, ABs, warfarin. Digoxin levels decrease 25% from PGP induction. PK: Induces 3A4, 1A2, PGP.

 

Phosphate Binder

lanthanum=Fosrenol: IND: End stage renal disease. EVD: Doesn’t affect Vit/cholesterol absorption like sevelamer. ADM: T w/ meals, chew or crush. AE: Naus10%,vom9%, abdominal pain5%. CI: Bowel obstruction. DOS: Std=750-1500mg/d divided TID. Max=4500mg/d.

sevelamer=Renagel=Renvela: IND: Used in ESRD. ADM: T w/ meals, don’t crush. AE: Naus, vom, diar, const, dyspepsia. CI: Bowel obstruction. DI: ciprofloxacin (decreased F by 50%), synthroid, doxycycline. Inhibits absorption of Vit A,D,K and cholesterol. DOS: 2.4g if phosphate between 1.8-2.4mM. If phosphate is >2.4mM then give 4.8g.

 

Probiotics

AVL: PO (powder, capsule, dairy products). MOA: May suppress growth of pathogenic bacteria, block attachment/invasion, enhance mucosal function and change host immune response. EVD: EFFECTIVE FOR: Antibiotic associated diarrhea in children (2w-17yo). Cochrane 2015 found RR=0.46 and NNT=10. Dose: Lactobacillus rhamnosus or Saccharomyces boulardii at 5-40 billion colony forming units/d. Also effective at preventing antibiotic associated C.difficile. Cochrane 2013 found RRR=64%. Dose: strain + dose not specified POSSIBLY EFFECTIVE FOR: Hepatic encephalopathy (no mortality benefit) Cochrane 2016, VAP preventionCochrane 2014, URTI preventionCochrane 2015, NOT EFFECTIVE FOR: UTI preventionCochrane 2015, UC remission maintenanceCochrane 2011. ADM: T at same time as antibiotics AE: Gas. OTH: Probiotic resource: clinical guide to probiotic supplements (app and site): http://www.probioticchart.ca/#/

 

Vitamins

Vitamin A: PRG: RDA=2500IUs. LAC: RDA=4333IUs. DOS: Adult RDA=2333-3000IUs. TUL=10,000IUs. OTH: RDA=2333-3000IUs.
Vitamin B1=thiamin: DOS: RDA Adult=1.1-1.4mg. OTH: Alcoholics are often deficient.


Vitamin B2=riboflavin: PRG: RDA=1.4mg. LAC: RDA=1.4mg. DOS: Adult RDA=1.1–1.6mg.


Vitamin B3=niacin: PRG: RDA=18mg. LAC: RDA=17mg. DOS: Adult RDA=14-18mg. TUL=35mg/d.


Vitamin B5=pantothenic acid: PRG: RDA=1.9mg. LAC: RDA=2mg. DOS: Adult RDA=1.3-2mg.


Vitamin B6=pyridoxine: PRG: RDA=1.9mg. LAC: RDA=2mg. DOS: Adult RDA=1.3-2mg. TUL=100mg/d.


Vitamin B7=biotin: PRG: RDA=30µg. LAC: RDA=35µg. DOS: Adult RDA=30-35µg.
Vitamin B9=folate: PRG: RDA=600µg. Recommended supplement=400µg/d. Should start supplementing 3 months before conception. LAC: RDA=500µg. DOS: Adult RDA=400-600µg. TUL=1000µg/d. Supplemental dose for disease prevention=200ug/d. Supplemental dose for folate replacement=1-5mg/d. OTH: Water-soluble vitamin. Found in leafy green vegetables, liver, legumes. Folic acid is a form of Vitamin B9 that needs to be activated.


Vitamin B12=cyanocolbalamin: IND: Macrocytic anemia. PRG: RDA=30µg. LAC: RDA=35µg. DOS: Adult RDA=30-35µg. Pernicious anemia: Oral or SL=1mg-2mg/d. SubQ/IM: 800-1000µg/d for 1-2w (to saturate stores) then 100-1000ug/w until Hgb, Hct are normal then 100-1000ug/month to maintain normal RBCs. OTH: Only dietary source is milk and meat.


Vitamin C: PRG: RDA=85mg. LAC: RDA=120mg. DOS: Adult RDA=75-120mg. TUL=2g/d.


Vitamin D: PRG: RDA=600IUs. LAC: RDA=600IUs. DOS: Adult RDA=600-800IU. TUL=4000IU/d.


Vitamin E: PRG: RDA=15mg. LAC: RDA=19mg. DOS: RDA=15-19mg. TUL=1000mg/d.


Vitamin K: PRG: RDA=90µg. LAC: RDA=90µg. DOS: Adult RDA=90-120µg.

 

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