How to deal with heart failure patients with hyperkalemia❓❓❓

Heart failure is a group of complex clinical syndromes caused by abnormal changes in the structure and/or function of the heart caused by a variety of reasons, causing ventricular contraction and/or diastolic dysfunction. It is the end stage of cardiovascular disease. Hyperkalemia is a common complication of heart failure, which can lead to severe arrhythmia and even life-threatening. 

Hyperkalemia is diagnosed when serum potassium> 5.0 mmol/L.

The risk of death is significantly increased when serum potassium is > 5.0 mmol/L. Therefore, hyperkalemia can be diagnosed with a serum potassium level  > 5.0 mmol/L. Serum potassium level  is 5.0-5.5 mmol/L, it is mild hyperkalemia. Serum potassium level  is 5.6-6.0 mmol/L, it is moderate hyperkalemia. Serum potassium level  is > 6.0 mmol/L, it is severe hyperkalemia. Serum potassium rises to more than 5.0mmol/L in a short time, which is an acute hyperkalemia. Repeated episodes of hyperkalemia within 1 year belong to chronic hyperkalemia.

Clinical manifestations of hyperkalemia.

The clinical symptoms caused by hyperkalemia are mainly related to the decreased excitability of myocardium and neuromuscular. The severity is related to the degree and speed of blood potassium increase, and whether it is combined with other electrolyte and water metabolism disorders. Mild hyperkalemia usually has no clinical symptoms. Acute severe hyperkalemia may cause brady paralysis, fatal arrhythmia, and even cardiac arrest and other serious consequences.

Diagnosis of hyperkalemia.

The diagnosis of hyperkalemia must exclude pseudo-hyperkalemia caused by hemolysis caused by improper blood sampling and inspection. When there is clinical doubt, it is recommended to repeat the examination to confirm the diagnosis and avoid making the wrong clinical treatment. The rare causes of hyperkalemia include rhabdomyolysis syndrome, tumor cell lysis syndrome, adrenal cortex hypofunction, etc. Related examinations are also required if necessary.

Treatment of heart failure combined with hyperkalemia.

1. General treatment and dietary advice.

Comorbidities, medication and diet should be fully evaluated after the diagnosis of hyperkalemia in patients with heart failure. For example, diabetes, chronic kidney disease and hypertension are comorbidities related to hyperkalemia. It should be actively treated once discovered. Although the commonly used drugs such as angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), β-receptor blockers and aldosterone receptor antagonists in patients with heart failure can cause hyperkalemia, they can still be used reasonably since it is of great significance to improve the prognosis of patients with heart failure. 

• Serum potassium > 5.5 mmol/L can reduce the dose and use potassium-lowering drugs as appropriate. Unless serum potassium is > 6.5 mmol/L or there is a critical situation related to hyperkalemia. The medicines should not be stopped suddenly. It is recommended to maintain serum potassium with using potassium-lowering drugs adequately and reasonably under stable conditions.

In terms of diet, for patients with serum potassium > 5.0 mmol/L and chronic hyperkalemia. It should limit appropriately the intake of high-potassium foods, such as potassium-containing salt, banana, oranges, tomatoes, potatoes and other high-potassium foods Intake. However, since foods generally contain potassium, strict implementation of a low-potassium diet may lead to insufficient intake of dietary fiber and various nutrients. Therefore, it is not recommended to implement an excessively strict low-potassium diet. Instead, long-term oral potassium-lowering drugs should be used to maintain blood potassium stability.

2. Treatment of acute episodes of hyperkalemia.

Stabilize the membrane potential of myocardial cells: intravenous calcium can be used as the first-line emergency treatment of hyperkalemia. The calcium administration process needs to be completed under ECG monitoring.

Promote the transport of extracellular potassium ions into the cell: insulin + glucose or sodium bicarbonate are commonly used treatment options.

Promote the excretion of potassium ions from the body: mainly include potassium excretion diuretics, cation exchange resins, new potassium ion binders and blood purification treatments.

• Potassium excretion diuretics: mainly include loop diuretics (such as furosemide) and thiazide diuretics (such as hydrochlorothiazide). Loop diuretics have a stronger potassium excretion effect than thiazide diuretics. For loop diuretics, the effect of intravenous administration is better than oral administration, and the combined effect of the two types of diuretics is better. The prerequisite for the use of diuretics is that the patient has good renal function and no hypovolemia, otherwise the curative effect will be poor and the condition may be aggravated.
• New potassium ion binders such as sodium zirconium cyclosilicate and Patiromer. The usage of SZC in acute hyperkalemia: The recommended starting dose is 10 g, 3 times a day, orally, and the medication should not exceed 48 hours. SZC has few adverse reactions, mainly diarrhea. Patiromer has a slower onset of effect after oral administration.
• Blood purification treatment: Hemodialysis is the most efficient way to remove potassium ions from the body. Hemodialysis is suitable for patients with continuous serum potassium> 6 mmol/L or abnormal electrocardiogram, and the effect of drug treatment is poor, especially for patients with heart failure who also have a water overload.

3. Treatment of chronic hyperkalemia.

Patients with chronic hyperkalemia need long-term use of potassium-lowering drugs to maintain blood potassium stability. The treatment measures need to consider safety, effectiveness and operability. In addition to the above general treatment and dietary recommendations, the following drug interventions can be taken:

For patients with metabolic acidosis, sodium bicarbonate can be used.

For patients with certain renal reserve, potassium excretion diuretics can be used, but the adverse reactions caused by long-term medication should be noted.

For patients with heart failure with extremely poor renal function and recurrent hyperkalemia, long-term dialysis can be used for treatment.

New potassium ion binders such as sodium zirconium cyclosilicate can maintain blood potassium stability for up to 1 year of treatment.

Prognosis and management of heart failure combined with hyperkalemia.

All patients with chronic heart failure should actively monitor blood potassium on a regular basis.

Read More

What should you do if your eyes are tired?😵😵😵

During the 24 hours a day, our eyes are in use at other times except for sleeping time. If you look at mobile phones, computers, TVs or books for a long time, I believe you will see things blurred sometimes. For example, the handwriting is blurred and confusing when reading or the wrong line is read when reading. In fact, this is some manifestations of asthenopia. In addition, if long-term asthenopia is not effectively alleviated, it can lead to a decline in visual function.

Causes of asthenopia.

Asthenopia is very common in clinical practice. It is caused by the sudden relaxation or convulsive contraction of the temporary ciliary muscle. There are many factors that cause asthenopia:

1. Use your eyes for too long.
2. The effect of object color.
3. Nervous.
4. Sleep disorder.
5. The effect of light.
6. Excessive smoking and drinking.
7. It is related to physical fitness.

Methods to prevent asthenopia.

1. In daily life, we can do more eye exercises.
2. Eyes should be used wisely to avoid using eyes for too long.
3. Exercise to enhance physical fitness. 
4. Avoid staying up late to ensure adequate sleep time.
5. Participate in outdoor activities. Let your eyes see the distance and green plants more.
6. Eliminate the unfavorable factors in the work and study environment, so that the eyes are in a comfortable eye environment.

Drugs to relieve asthenopia.

In addition to improving daily eye habits, we may also need to use drugs at certain times. However, there are many kinds of eye drops on the market and not every one is suitable for us. If we choose the wrong one, it will cause irreversible damage to our eyes.

1. Artificial tears

Artificial tears are currently the safest medicine to relieve eyesight fatigue. It mainly simulates natural tears, which can form a protective film of tears on the surface of the eyes and reduce the loss of water in the eyes. When the eyes are dry, artificial tears can appropriately relieve the symptoms and do not contain any anti-allergic or anti-inflammatory ingredients. In addition, some artificial tear products contain antiseptic ingredients. Long-term use of artificial tears containing antiseptic ingredients will cause damage to the eyes.

Commonly used drugs are: sodium hyaluronate eye drops, polyethylene glycol eye drops, sodium carboxymethyl cellulose eye drops, hydroxysugar eye drops and so on.

The main component of sodium hyaluronate eye drops is sodium hyaluronate, which imitates the normal components of human tears. It can moisten the cornea and promote the healing of corneal wounds. It is mainly used for the treatment of dry eye and alleviating symptoms of eye dryness. Therefore, if there are symptoms such as dryness, soreness and foreign body sensation in the eyes, and it is clear that it is dry eye after examination, you can choose sodium hyaluronate eye drops to relieve the symptoms. However, although artificial tears are safe, they cannot be abused. Generally, it should be controlled 3-4 times a day. Some patients with severe dry eye can increase the number of medications depending on the situation. Under normal circumstances, no more than 6 times a day is appropriate.

2. Chondroitin sulfate eye drops

There are many different products on the market for chondroitin sulfate eye drops. For example, chondroitin sulfate + taurine, chondroitin sulfate + taurine, chondroitin sulfate + vitamin E + vitamin B6 + allantoin + taurine, etc., can all improve the symptoms of eye fatigue and dry eye.

Chondroitin sulfate is an acidic mucopolysaccharide, which is one of the important components in eye tissue. It has the functions of improving microcirculation, regulating cell growth, protecting the cornea and promoting the repair of corneal tissue damage. At the same time, it can also promote corneal water metabolism, form a protective film on the surface of the cornea, prevent water from dissipating, effectively relieve eye fatigue and dry eye symptoms. 

Taurine is an amino acid antibacterial and anti-inflammatory drug. In addition to its antibacterial and anti-inflammatory effects, it also participates in a variety of physiological activities in the eye tissues, promotes metabolism and improves asthenopia symptoms.

👉In addition, we can eat foods rich in lutein such as carrots, cabbage, corn, spinach, and kiwi. Lutein is an antioxidant. It is the main pigment that constitutes the macular area of the retina of the human eye. If it is lacking, vision will decrease and the eyes are easily dim. Therefore, it is very important to properly supplement foods containing lutein.

Read More

A commonly used antiplatelet drug: Clopidogrel👴👴👴

Clopidogrel is an antiplatelet drug that is indicated for preventing thrombotic events in patients with ischemic stroke, myocardial infarction and peripheral arterial disease. However, although antiplatelet drugs can prevent thrombosis, they can also cause serious adverse reactions such as bleeding. Therefore, every patient taking clopidogrel should know how to take it correctly.

1. Is Clopidogrel taken before or after a meal?

Recommended dosage: 75mg each time, once a day. 

Recommended usage: Oral, with or without food.

The medication is taken at a fixed time, either before or after a meal. If the patient can tolerate it, the medication time should not be changed at will.

2. What should you do if you miss taking a dose?

After oral administration of clopidogrel 75 mg, the elimination half-life of clopidogrel is 6 hours and the elimination half-life of active metabolites is about 30 minutes. If a missed dose is found within 12 hours of the regular medication time, the patient should take a standard dose immediately and take the next dose according to the regular medication time. If a missed dose is found 12 hours after the regular medication time, the patient should take the standard dose at the next regular medication time without doubling the dose.

3. Pharmacokinetic characteristics.

Clopidogrel is a prodrug. After oral absorption of clopidogrel through the intestine, most (about 85%) are hydrolyzed by esterase into inactive carboxylic acid derivatives, and only 15% is converted into thiol metabolites with antiplatelet activity by CYP2C19. Inactive carboxylic acid derivatives are strong inhibitors of CYP2C8. CYP2C19 is a key enzyme for the activation of clopidogrel. Due to the genetic diversity of CYP2C19, weak metabolizers of CYP2C19 will have a reduced response to clopidogrel. Clinically, the patient's genotype can be tested. If it is a weak metabolizer, it is recommended to switch to other antiplatelet drugs.

4. Avoid combination with repaglinide.

Repaglinide is a commonly used hypoglycemic agent in clinical practice. It reduces postprandial blood sugar by stimulating the early secretion of insulin, which can cause fatal hypoglycemia. Repaglinide is mainly metabolized by CYP2C8 and CYP3A4. Because the inactive carboxylic acid derivatives of clopidogrel can significantly inhibit CYP2C8, the combination of clopidogrel and repaglinide can inhibit the metabolism of repaglinide in the body. It will increase the blood concentration of repaglinide by 3.9 to 5.1 times and increase the risk of hypoglycemia. Therefore, clopidogrel should be avoided in combination with repaglinide.

5. Can clopidogrel be used in combination with proton pump inhibitors?

Clopidogrel can increase the risk of gastrointestinal bleeding. Combined use with proton pump inhibitors can reduce the bleeding risk of clopidogrel. Clopidogrel is a prodrug. It can become an active substance that can inhibit platelet aggregation after being transformed by CYP2C19 in the body. Therefore, CYP2C19 inhibitors can reduce the antiplatelet effect of clopidogrel. Omeprazole and esomeprazole can inhibit CYP2C19, leading to the inhibition of clopidogrel's conversion into active metabolites, reducing its efficacy. Therefore, clopidogrel should not be combined with omeprazole and esomeprazole. According to its drug instructions, clopidogrel can be combined with pantoprazole. However, the combination of clopidogrel and PPI is not recommended clinically. If you must use them together, you should avoid the use of omeprazole and esomeprazole.

Read More

People who go to the toilet and play with mobile phones should pay attention.😐😐😐

The toilet was supposed to be a place to defecate, but with the popularity of smartphones, more and more people like to play with their phones while going to the toilet. Especially young people, many of them take out their phones to play games, watch videos and use social apps as soon as they go to the toilet. It always takes more than half an hour to go to the toilet. In fact, this is not only unsanitary, but also harmful to health.

1. Cause constipation.

The seemingly simple movement of defecation requires the coordination and participation of more than 100 muscles in the body, and the whole process is finely regulated by the brain. If you focus too much on your phone during defecation, you cannot concentrate on defecation. It will reduce the brain's precise control of the small muscles, thereby disrupting normal bowel movements. Over time, it is more likely to cause habitual constipation and even the anus becomes weakened. It will be difficult to feel the bowel movement.

2. Sitting in the toilet for too long can cause hemorrhoids and even bowel cancer.

Going to the toilet and playing on the phone, time passes very quickly. The things that can be done in a few minutes will be stretched to tens of minutes or even an hour. 

Sitting in the toilet for too long will lead to obstruction of pelvic venous blood return, induce hemorrhoids and even lose the rectal sensitivity to fecal stimulation. It will cause habitual constipation and may severely induce bowel cancer.

3. The longer you sit, the easier your legs will numb.

The longer you sit, it will cause poor blood circulation in the legs and affect the normal conduction of nerves. Peripheral nerves are compressed, and the stimulation cannot be transmitted to the brain accurately and in time, which will make people feel numb in the legs and feet. This will make it difficult for you to even stand up. 

4. Causes hypoxia in the brain and heart.

Since the toilet is a closed environment, staying in it for a long time can also cause hypoxia in the brain and heart. People with cardiovascular disease who suddenly stand up after squatting for a long time are also prone to transient cerebral ischemia, fainting with orthostatic hypotension and even sudden death.

5. Economic crisis

If the phone is unfortunately dropped into the toilet, would you still use it or take it for repair? It is not cheap to buy a new phone.😭

Moreover, playing with mobile phones in the toilet is really dirty. There are many bacteria in the toilet, which may take the opportunity to attach to the mobile phone and spread diseases. Therefore, playing with mobile phones in the toilet is harmful to no benefit. 

In addition to playing with mobile phones, there are also ways to make mistakes when going to the toilet.

1. Excessive force when defecation.

Some people are constipated, so in order to defecate, they will use a lot of pressure to compress the abdomen. This is actually very dangerous. When the force is exerted, the related muscles will also be exerted, so that the abdominal pressure and blood pressure will rise accordingly. For people with related heart diseases, it is even more likely to make the heart beat faster and increase the oxygen consumption of the heart machine. In severe cases, it may even induce myocardial infarction.

2. Wrong direction of wiping butt.

Should you wipe your butt "from front to back" or "from back to front" after going to the toilet? The correct approach is "from front to back". If you wipe your butt "from back to front", you should change it. Because there are vagina and urethra in front of the anus, if you wipe it from the back to the front, the stool will be wiped on them. Moreover, the defense of the vagina and urethra against germs is much lower than that of the anus. It is easy to be infected. Especially women, regardless of whether they urinate or defecate, they should wipe from the front to the back. Because the male urethra is far away from the anus, the wiping method is not too particular, just follow the habit.

3. Get up too fast after sitting for a long time.

If you sit in the toilet for too long, you can easily get dizzy if you suddenly stand up. Especially for patients with cardiovascular and cerebrovascular diseases, it is very dangerous. Standing up after sitting on the toilet for a long time may induce transient cerebral ischemia, leading to accidents such as fainting and fractures. The older you are, the more likely you are to get injured.

Read More

Some seemingly good health habits are actually harmful to health.😖😖😖

Some good health habits are good for health in themselves. However, some people make these habits wrong. Not only is it not good for health, but it is harmful to health. Here are some good habits that are often made wrong.

1. Drink a glass of light salt water after getting up.

Drinking a glass of water in the morning can not only replenish the water lost during sleep, but also reduce blood viscosity and promote blood circulation. Especially like the dry season now, you should drink water in time. 

However, some people will add a small amount of table salt to the water. They think that it can help defecation and anti-inflammatory and sterilization. First of all, table salt is a common condiment. It does not help defecation and sterilization. In addition, drinking light salt water in the morning may aggravate dehydration. In the process of sleeping, people consume a lot of water. Therefore, after getting up, the blood is in a concentrated state. Drinking light salt water at this time will aggravate dehydration and make people feel more thirsty. Moreover, the morning is the first peak of human blood pressure. Drinking light salt water at this time will make blood pressure higher and increase the burden on the heart. In addition, excessive salt intake can cause many harms such as accelerating calcium loss, increasing the burden on the kidneys and even causing kidney disease.

Therefore, It is recommended to drink a glass of warm water in the morning and other drinks are not recommended.

2. Take a walk after a meal.

After eating, it is best to rest for 20-30 minutes before going out for a walk.

The previous article has a detailed explanation. If you want to know more, click

👉Is it correct to sit or take a walk after a meal?

3. Soak your feet before going to bed.

It's suitable for soaking your feet in winter, which not only keeps you warm, but also relieves fatigue and helps you sleep. Moreover, soaking feet is particularly comfortable and many people are reluctant to get up after soaking.

However, if you soak your feet for too long, it may be harmful to your health. When the feet are soaked, the blood of the whole body will accelerate the circulation to the lower body until the soles of the feet. If the soaking time is too long, it will increase the burden on the cardiovascular and cerebrovascular. Especially for people with cardiovascular disease, it will lead to insufficient blood supply to the brain and heart. It can cause the symptoms such as dizziness, dizziness and even lead to accidents. In addition, soaking feet can also cause local blood vessels to dilate. People with vascular diseases should avoid to soak their feet to avoid accidents.

4. Take a hot bath before going to bed.

Many people think that taking a hot bath before going to bed makes their whole body warm, comfortable and it can help sleep. But actually taking a hot bath before going to bed not only does not help you sleep, it can also make it difficult for you to fall asleep. 

A drop in body temperature is a good state of sleep. When people are just after taking a hot bath, the body temperature will rise and it is not suitable for sleeping right away. Many people tend to feel more energetic after taking a hot bath, which can make people unable to sleep.

Therefore, it is recommended that you take a bath 1.5 to 2 hours before going to bed to increase your body temperature. Then, the body automatically adjusts the temperature. After about 2 hours, the body temperature drops and causing drowsiness. In addition, do not wear too much when sleeping, otherwise it will easily increase the body temperature and affect sleep. It is recommended to wear thin clothes to sleep.

5. Drink double-boiled soup to supplement nutrition in winter.

In China, many people drink double-boiled soup to supplement their nutrition in winter. Double-boiled soup usually takes 3 hours to boil the soup and 4 hours to simmer. Many people also think that the longer the soup cooks, the more nutritious it will be. However, if the soup is cooked for too long, the fat and purine content in the soup is very high, which can easily cause diseases such as high blood pressure and gout. If vegetables are added to the soup, cooking for too long will cause the nutrients in the vegetables to be lost. In addition, the potassium and oxalate content in the soup is increased. Long-term drinking will increase the risk of kidney stones.

The meat soup is boiled for about 1 hour and the longest is no more than 2 hours. The fish soup time is controlled within 1 hour. Normal people should not drink double-boiled soup more than 3 times a week. People who are obese or suffering from cardiovascular or kidney disease should drink less.

Read More

What is the difference between antacids, H2 receptor blockers and proton pump inhibitors❓❓❓

Gastrointestinal diseases are common diseases in daily life, and there are many types of treatment drugs, such as gastric acid secretion inhibitors, antacids, gastric mucosal protective drugs, and gastrointestinal motility drugs. They have their own characteristics, different mechanisms of action, indications and usage. Therefore, we must learn to choose more accurately and use drugs rationally according to the characteristics of stomach diseases. Gastric acid secretion inhibitors and antacids are two drugs that are frequently used in digestive tract diseases. Here we briefly describe the differences in their pharmacological mechanisms, indications, usage and dosage, adverse reactions and precautions.

1. Pharmacological mechanisms

Gastric acid secretion inhibitors

    H₂ antagonist:

• It can block H₂ receptors of parietal cells. It inhibits basic gastric acid and nocturnal gastric acid secretion. It also inhibits gastric acid secretion caused by gastrin and M receptor agonists. Studies have shown that H₂ antagonist has a significant inhibitory effect on gastric acid secretion at night, but it has a poor control effect on gastric acid secretion during the day.
• Commonly used drugs: cimetidine, famotidine, ranitidine.
•  Acid suppression strength: famotidine > ranitidine > cimetidine.

    Proton pump inhibitor (PPI)

• It is an H⁺/K⁺-ATPase inhibitor that can inhibit central or peripheral gastric acid secretion. It can effectively inhibit basic gastric acid secretion or various forms of stress-induced gastric acid secretion.
• Commonly used drugs: Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole.
• Acid suppression strength: esomeprazole > rabeprazole > pantoprazole > lansoprazole and omeprazole.

Antacids

• They are weakly alkaline substances, which directly neutralize gastric acid in the stomach after oral administration and increase the pH of the gastric juice to reduce the activity of pepsin (when the pH of the gastric juice is 1.5-2.5, the most active). Antacids such as aluminum hydroxide neutralize gastric acid and cover the gastric mucosa to form a gel-like protective layer to prevent gastric acid and pepsin from invading again.
• Commonly used drugs: aluminum hydroxide, aluminum phosphate, magnesium hydroxide, sodium bicarbonate.

2. Indications

Gastric acid secretion inhibitors

• Acute gastric mucosal disease, gastroesophageal reflux disease, peptic ulcer or bleeding, prevention of stress mucosal injury of upper gastrointestinal tract. PPI can be combined with antibacterial drugs to eradicate Helicobacter pylori.

Antacids

• Relieve stomachache, acid reflux and heartburn caused by hyperacidity. It can be used for functional dyspepsia, chronic gastritis, peptic ulcer or bleeding, acute gastric mucosal lesions and reflux esophagitis.

Different

• Antacids directly neutralize gastric acid and have a quick effect. However, as the stomach empties and cannot neutralize the continuously secreted gastric acid, the duration of action is very short. PPI has a strong, complete and long-lasting acid-inhibiting effect, and its acid-inhibiting ability greatly exceeds that of H₂ antagonist. Usually, the time for antacids to make the stomach pH> 4 is only 4 hours, H₂ antagonist is 8 hours and PPI can reach 18 hours.

3. Dosage

Classification	Drug name	Dosage	Taking time
H2 antagonist	Cimetidine	0.2g/time, 2 times/day, daily dose ≤0.8g	During meal and before bedtime
	Famotidine	20mg/time, 2 times/day, the daily dose is 40mg.	After breakfast, dinner or before bedtime.
	Ranitidine	0.15g/time, 2 times/day	Early morning and before bed
PPI	Esomeprazole	20-40mg/time, 1-2 times/day	1h before meal
	Ilaprazole	5-10mg/time, 1-2 times/day	Take it on an empty stomach in the morning
	Lansoprazole	30mg/time, 1-2 times/day	0.5h before meal
	Omeprazole	20mg/time, 1-2 times/day 0.5h before meal	0.5h before meal
	Pantoprazole	20-40mg/time, 1-2 times/day	1h before meal
	Rabeprazole	10-20mg/time, 1-2 times/day	0.5h before meal
Antacids	Aluminum hydroxide	0.6-0.9g/time, 3 times/day	1h before meal
	Aluminum Phosphate Gel	1-2 packs/time, 2-3 times/day	0.5h before meal
	Sodium bicarbonate	0.3-1g once, 3 times a day.	Before meal

H₂ antagonist has no obvious irritation to gastric mucosa, and its absorption and utilization are basically not affected by gastric contents. Generally, it can be taken after a meal or before going to bed.

Since PPI has an inhibitory effect on the "active pump" on the cell membrane of the gastric parietal cell, it has no effect on the "rest pump" in the cytoplasm, and the proton pump regeneration is mainly completed at night, so the best effect is to take the drug in the morning. PPI can only obtain the maximum acid suppression effect when it acts on food to stimulate the gastric parietal cells to be active. Therefore, it is recommended that PPI be taken 15 to 60 minutes before a meal in the morning.

The purpose of taking antacids is to neutralize excessive stomach acid, so it is generally best to take it half an hour before a meal or when stomach pain occurs.

4. Course of treatment

H₂ antagonist is generally taken continuously for no more than 12 weeks.

PPI is used for gastric ulcer medication for 6 to 8 weeks and duodenal ulcer is 4 weeks. The course of anti-Helicobacter pylori treatment is 10 to 14 days. The course of treatment for gastroesophageal reflux disease should be at least 8 weeks. Preventive use of PPI, elective surgery: Use one dose before surgery and use ≦ 24h after surgery. Fasting or parenteral nutrition: After establishing enteral nutrition, consider stopping PPI.

Antacids are generally taken for no more than 7 consecutive days.

5. Adverse reactions

Gastric acid secretion inhibitors

H₂ antagonist may induce rapid drug resistance during use and may cause gastric acid rebound after stopping. Others include nausea, vomiting, diarrhea, leukopenia, elevated serum transaminase, male sexual dysfunction and breast enlargement, galactorrhea and neuropsychiatric symptoms such as headache, dizziness, hallucinations, mania, etc.

Adverse reactions caused by short-term use of PPI are rare, such as headache, diarrhea, nausea, gastrointestinal flatulence, abdominal pain, constipation, dizziness, itching, and rash, etc., which are generally mild. Long-term treatment (>1 year), long-term overdose (>1.75 times the standard dose) may cause serious adverse reactions, such as osteoporosis and fractures, pneumonia, intestinal infections, iron deficiency anemia, vitamin B12 deficiency, hypomagnesemia and gastric mucosal lesions.

Antacids

Long-term use of aluminum hydroxide can cause severe constipation and even intestinal obstruction. Long-term use of aluminum hydroxide in the elderly can affect the intestinal absorption of phosphate, which can lead to osteoporosis. Large doses of aluminum phosphate can also cause mild constipation. Aluminum salt is absorbed and deposited in the brain, which can cause senile dementia.

Magnesium hydroxide can easily cause diarrhea.

Repetitive use of large doses of sodium bicarbonate can easily cause abdominal distension, sodium retention and secondary gastric acid secretion. Eating dairy products during medication may cause milk-alkali syndrome (manifested by nausea, vomiting, weakness, polyuria, and muscle pain).

6. Precautions

Gastric acid secretion inhibitors

    H₂ antagonist

• Antacids can reduce the concentration of gastric acid and form a protective film on the surface of the ulcer, thereby hindering the absorption and function of H₂ antagonist. Therefore, H₂ antagonist should not be combined with antacids.
• Avoid the combination of H₂ antagonist and PPI unless there is a nighttime acid breakthrough (taking PPI during the day and taking H₂ antagonist before going to bed can significantly reduce the incidence).
• Cimetidine can inhibit the activity of liver cytochrome P450 and can interact with warfarin, phenytoin and other drugs. The dose needs to be adjusted when combined. Ranitidine has a weak effect on liver drug enzymes and famotidine has almost no effect.
• In order to reduce the occurrence of the rebound phenomenon of H₂ antagonist withdrawal, it is generally advocated to stop the drug by the decrement method, such as changing from 2 times a day to once a day, then to once every other day after 1 week, and gradually stop the drug.

    PPI

• PPI needs to be combined with H⁺. It activated in an acidic environment and irreversibly combined with the sulfhydryl group of the proton pump through the disulfide bond. It causes the proton pump is permanently inactivated. Therefore, PPI should not be combined with antacids.
• It has liver enzyme inhibitory effect. Combining with clopidogrel can reduce the efficacy of the latter. Among them, omeprazole has the most obvious inhibitory effect, and PPI with weaker CYP inhibition (such as pantoprazole) may be a better choice.
• Mucosal protective agents such as sucralfate need to form a protective film in an acidic environment. Acid inhibitors increase the pH of the stomach and reduce the efficacy of such drugs. Since mucosal protective agents are attached to the surface of the gastric mucosa, they can affect the activation of PPI. Therefore, the two types of drugs should not be used in combination, and the two should be taken separately.

Antacids

• The main factors affecting the efficacy of antacids include drug neutralization ability, gastric acid secretion and emptying rate. Prolonging the action time of the drug in the stomach can enhance the curative effect, and the prokinetic drug will shorten the residence time of the antacid in the stomach when promoting intestinal motility. Therefore, it is not recommended to take the prokinetic drug and antacid at the same time. In addition, the effect of increasing the frequency of administration is better than increasing the single dose.
• Aluminum can affect the absorption of certain drugs, such as tetracycline, iron, digoxin, cimetidine, etc., when the two are used together, an interval of 1-2h is required.

Read More

How to use Cefdinir?👀

Cefdinir is a semi-synthetic third-generation cephalosporin, which is stable to β-lactamase and has good antibacterial activity against Gram-positive and Gram-negative bacteria. Cefdinir has the advantages of good oral absorption, high antibacterial activity, high blood concentration and wide tissue distribution. It has a good treatment effect on mild to moderate respiratory tract infections and skin and soft tissue infections. It is one of the commonly used clinical antibacterial drugs. Some patients feel very alarmed when they have red urine or red stool after using cefdinir. They may mistakenly think it is hematuria or bloody stool and be confused whether they should continue taking it. The following will explain the precautions for using cefdinir.

1. Strictly comply with medication indications

Before using antibiotics, the first choice should be to clarify whether it is a viral infection or a bacterial infection. Antibacterial drugs can only be applied when a bacterial infection is used. 

Suitable for the following mild and moderate infections caused by sensitive bacteria:

Adults and teenagers

1. Community-acquired pneumonia.
2. Acute attack of chronic bronchitis.
3. Acute maxillary sinusitis.
4. Otitis media.
5. Scarlet fever.
6. Pharyngitis or tonsillitis.
7. Uncomplicated skin and soft tissue infections.

Child

1. Acute otitis media.
2. Pharyngitis or tonsillitis.
3. Uncomplicated skin and soft tissue infections.

2. Dosage

The usual dose for adults is 0.1g once, 3 times a day. The recommended dosage and course of treatment for adults and adolescents (over 13 years old) are as follows: 

• For all infectious diseases, the maximum daily dosage of this medicine is 600mg and 10 days is a course of treatment. One dose daily is equivalent to two doses daily, but twice a day is required for pneumonia and skin infections. If the patient's weight is relatively low, condition is relatively mild or the above-mentioned dosage cannot be tolerated. A 100 mg dose, 3 times a day, can also be used.

Recommended regular dose for children: Orally, 9~18mg/kg a day, taken in 3 divided doses. 

• Children 6 months to 12 years old have acute bacterial otitis media, acute maxillary sinusitis, tonsillitis, pharyngitis, simple skin and soft tissue infections. The dose is 1 time every 12 hours, 7mg/kg each time or 1 time every 24 hours, 14mg/kg each time.
• The dose for children with community-acquired pneumonia is once every 8 hours, 3-6 mg/kg each time, with a maximum dose of 200 mg once.

3. Caution and contraindications

Use with caution:

1. People who have a history of allergies to penicillin or cephalosporin drugs.
2. Those with severe renal impairment.
3. Those with poor eating conditions, non-oral intake of nutrients, severe underlying diseases and cachexia (Vitamin K deficiency may occur when using cefdinir and close observation is required).

Contraindications: 

1. Patients with a history of severe allergies to drugs.

4. Medication method

It can be taken before or after a meal (The absorption of cefdinir after a meal is slightly reduced).

Mainly cause gastrointestinal side effects (such as diarrhea, abdominal pain) and skin side effects (such as rash, itching).

Red urine may appear during medication. When combined with iron-containing foods, red stools may appear. This is normal and you can continue to take the drug.

The following drugs will interact with cefdinir and need to be used at intervals:

• Cefdinir has antibacterial activity, which may reduce the effect of drugs containing live bacteria. If you need to use it in combination, please use it at an interval of 2 hours.
• Medications that need to be taken 2 hours apart: antacids (such as aluminum hydroxide).
• Medicines that need to be taken at least 3 hours apart: iron salt drugs (such as ferrous sulfate, iron citrate, iron hydroxide).
• Medications that need to be taken 4 hours apart: Acetylcysteine.

👉Cefdinir has a broad antibacterial spectrum, high local concentration in inflammatory tissue, high bioavailability, high efficiency and low side effects. It has a good effect on children with mild to moderate infections. Paying attention to the precautions during the administration can ensure the maximum effect of the drug and avoid the risk of medication.

Read More

A few good sleeping habits will improve your quality of life.👍👍👍

When it comes to sleeping habits that are bad for your body, you will definitely think of staying up late. But apart from staying up late, some sleeping habits are actually harmful to the body. And some people think that sleeping habits are good for the body, but it will actually make you tired the more you sleep and it even hurts your body than staying up late. 

Sleeping habits may hurt your body.

1. Get up early

Although early to bed and early to rise is good for your health, sometimes people mistakenly think that getting up early is also good for your health. In fact, waking up early is sometimes more harmful than staying up late. Some people insist on getting up early no matter what time they fall asleep. In fact, this is the same as staying up late. It is because the lack of sleep time will cause the symptoms of lack of sleep. Lack of sleep can cause symptoms such as dizziness, headache, decreased concentration and irritability. Long-term lack of sleep can cause immune dysfunction in the body and increase the risk of dementia, cardiovascular and cerebrovascular diseases, digestive tract diseases and immune diseases. Studies have found that the same sleep time is 4 hours and the state of the participants who slept from 23:00 to 3:00 was worse than that of the participants who slept from 3:00 to 7:00. 

Therefore, it is recommended that you do not seek to get up too early. Sufficient sleep time is the most important thing.

2. Plants in the bedroom

Putting some flowers and plants indoors can not only decorate the bedroom, but also purify the air and relieve tension. However, it is recommended not to put it in the bedroom, especially the headboard. First, green plants only perform respiration at night. At this time, plants absorb oxygen and release carbon dioxide. It is easy for people to stay in an oxygen-deficient environment for a long time and it is difficult to enter deep sleep. It causes continuous fatigue. On the other hand, there may be a large number of molds hidden in the flower-growing soil, which can cause respiratory diseases such as allergies or asthma if placed on the bedside. 

In addition, there are some plants that can make people sick such as insomnia and allergies. It is not recommended to put flowers in the bedroom.

3. Turn on the night light to sleep

For convenience at night, many people will install a night light in the bedroom. Some people will keep it open until dawn. But from a health perspective, the night light should not be on all night. 

When a person sleeps in a dark environment, the pineal gland of the brain secretes a substance (melatonin) closely related to human sleep. Melatonin can induce sleep, enhance immunity, regulate body temperature, eliminate fatigue and make people energetic after waking up. However, turning on the night lights to sleep will produce a kind of "light pressure", which will inhibit the secretion of melatonin. It will affects the body's various endocrine activities. Sleeping with the night light on can also be harmful to your child's eyesight. Because the child's eyelids are relatively thin. They can still sense faint light when they close their eyes. After the daytime activities, the night is the time to get a rest, but the light of the small night light will constantly stimulate the eyes.

It is recommended that you turn off the night light when you sleep, and turn it on when you use it.

4. Use a humidifier while sleeping

As soon as winter arrives, the indoor air becomes very dry. Many people use humidifiers. In order to make the air more humid, many people sleep with a humidifier on all night. In fact, this is actually bad for the body. If indoor air humidity is too high, sweat will not evaporate smoothly, bacteria, dust mites, and mold will also breed, causing respiratory discomfort and severe damage to the health of the lungs. 

In addition, when you are using a humidifier, it is not recommended to add tap water. It is best to add cool boiled water, distilled water or mineral water. This is because the content of magnesium, calcium, chlorine and other substances in tap water is relatively high. Chlorine will be volatilized into the air by the humidifier and long-term use will cause air pollution. Calcium, magnesium and other substances are easy to deposit and form scale. They can block the spray hole of the humidifier. It reduce the humidification efficiency and affect the service life.

It is recommended to change the water of the humidifier daily and it is best to clean it once a week. This can prevent the growth of microorganisms such as molds, thereby avoiding infection with germs.

Some suggestions for improving sleep quality.

1. Eat some sleep-help foods

Eat some sleep aids at dinner, such as bananas, cherries, cheese, pumpkin seeds, scallops, shiitake mushrooms, sunflower seeds, black sesame seeds, etc.

2. Create a good sleeping environment

A quiet, clean and dark environment can help you fall asleep quickly. Therefore, while keeping the bedroom clean, you can choose comfortable, soft pillows and loose pajamas. At the same time, turn off the night light, turn off all kinds of luminous or sound items and close the curtains.

3. Sleep regularly

Irregular sleep time will not only affect the quality of sleep, but may also disrupt the body clock. It makes people feel difficulty concentrating, sleepy during the day, insomnia at night and unable to fall asleep. Adults are best to go to bed before 11 o'clock in the evening, sleep 6-8 hours a day. The nap time should not more than 20-30 minutes. 

Sleep time will vary from person to person. Find out the most suitable sleep time according to your mental and physical state.

Read More

What should I do if my child is often constipated?👦👧

Children have irregular bowel movements and it is very difficult to defecate. What should you do? In fact, constipation in children is very common. If the child's body has no major problems after the examination, it is probably related to improper diet or intestinal dysfunction. This situation can often be resolved by adjusting the children's diet. But how should we adjust the details? The following will explain a little.

Can children with constipation take medicine?

For children with constipation, the most effective and recommended treatment is non-drug methods. It mainly recommend to improve the coordination between the abdomen and pelvic floor muscle tissue. If the child takes laxatives too early, the child may continue to have symptoms of constipation. In fact, there are many reasons for children's constipation, which may be caused by abnormal diet, lack of water, insufficient exercise or intestinal diseases. It is more important to find out the cause of constipation for children's constipation than to use stool laxatives.

First of all, we should observe whether the child has a partial eclipse habit?

Children often have partial eating habits, such as eating only meat, not eating vegetables, drinking very little water every day, or eating snacks instead of regular meals. Children who have a partial eclipse should find ways to encourage them to eat more fruits and vegetables such as making fruits and vegetables into interesting patterns to attract children to eat. You should also try to make children drink more water every day. Children over 1 year old should drink more than 1000 ml of water per day. And you should not let children drink juice or milk instead of drinking water.

In addition, you can try to help your child develop a habit of defecation on time.

If the child does not have the habit of defecation on time, try to help him develop it. For example, let the child sit on the toilet for 5-10 minutes within 20-30 minutes after eating, 1-2 times a day to help the child develop the habit of defecation on time. Especially after breakfast, children are more likely to defecate. 

Posture: When going to the toilet, children should sit with their feet supported and the knees just above the hips. You can use a small stool or a book to achieve this posture.

Breathing training: Breathing training is very helpful to improve the muscles of the pelvic floor and can relax the anal sphincter. It is recommended to teach children to practice the movements of blowing candles and smelling flowers. It can prevent children from holding their breath during defecation.

Regular exercise can also strengthen the child's core strength and accelerate the peristalsis of the intestines.

Adjust the digestive function of the child's gastrointestinal tract.

When children have problems with defecation and indigestion, you can supplement with probiotics to increase the good bacteria in the intestinal tract. When you select probiotics, you can choose Lactobacillus acidophilus and Bifidobacterium species to help adjust the intestinal function. Probiotics can added to warm water for drinking, but the water temperature should not exceed 40°C. At the same time, this can increase the child's drinking water. 

👉If you have tried all of the above methods and the children's constipation has not improved. You are advised to seek medical attention.

Read More