Anemia deficiencies

 

Drugs for Deficiency Anemias:

Iron Deficiency Anemia:: the most common nutritional deficiency affects 5% of the population:

Causes:

  1. Children
  2. Iron Def (Rare before 6 mo of age)
  3. Lead Poisoning
  4. a. sickle cell
  5. thalassemia
  6. Premenopausal Women
  7. Menorhagia 2 mg/d iron lost
  8. Dietary Iron abs;1.5-1.8
  9. Pregnancy: 500-1000 mg iron lost
  10. Males and Post Menopausal Women:
  11. Colon Ca
  12. GI blood Loss
  13. gastritis
  14. .PUD
  15. Partial Gastrectomty
  16. Bariatric Surgery
  17. Diverticulitis
  18. UC
  19. Celiac

S/S:

  1. PICA
  2. Fatigue
  3. Weakness
  4. DOE
  5. Light headedness
  6. Pruritis
  7. glossitis
  8. restless leg

Tx- Salts:

Ferrous Sulfate (feosol) 65mg /325mg tablet PO TID (max 200mg/d)

Children: 5mg/kg/day given over 3-4 doses

DOC for iron def, least expensive

  1. iron abs reduced 40% with meals
  2. Ideally in between meals

S/E

  1. GI disturbances – can cause PUD, UC
  2. Staining of teeth
  3. Toxicity (overdose)

OTHERS:

Ferrous fumarate (Feostat) 33mg/100mg capsule

Ferrous gluconate (fergon) 39mg/325mg tablet

  • The only difference is their amount of elemental iron per product
  1. Macrocytic Anemia
  1. Pernicious Anemia (B12 Deficiency )
  2. Causes:
  3. decreased IF
    1. gastritis
    2. gastric bypass
    3. autoimmune parietal cell destruction
    4. insufficient IF production
  4. Malabsoption
    1. chrons
    2. zollinger Ellison syndrome
    3. whipple disease
    4. infection (tape Worm)
  5. Inadequate B12 intake
    1. Vegan
    2. Elderly
    3. Alcoholism
    4. Vegetarian mothers who exclusively breastfeed

S/S

  1. generalized weakness
  2. paresthesias
  3. leg stiffness
  4. ataxia
  5. memory impairment
  6. personality change
  7. depressed mood

Signs:

5 P’S

  1. pancytopenia
  2. peripheral neuropathy
  3. posterior spinal column neuropathy
  4. pyramidal tract signs
  5. papillary atrophy of the tongue

Neurological:

  1. cognitive impairments
  2. gait disturnbances
  3. peripheral neuropathy
  4. generalized weakness

Psychiatric:

  1. depression
  2. psychosis
  3. optic neuritis

GI

  1. anorexia
  2. glossitis
  3. jaundice

Skin

  1. Hyperpigmentation
  2. Vitiligo

Treatment:

  1. Cyanocobalamin tablets
    1. Preparations: 25 mcg, 50 mcg, 100 mcg, 250 mcg tablet
    2. Initial: 2000 mcg PO daily for 2 weeks to 4 months
    3. Maintenance: 1000 mcg PO daily
  1. Cyanocobalamin nasal gel 500 mcg each week
    1. Preparations: 400 ug/0.1 ml nasal gel
    2. Initial: 1500 mcg weekly intranasally for 3-4 weeks
    3. Maintenance: 500 mcg weekly
  2. Cyanocobalamin injection
    1. Initial: 1000 mcg IM daily for 2 weeks
    2. Maintenance: 1000 mcg IM every 1-3 months
  1. Folic Acid Deficiency (rare in the US)

Causes

  1. Inadequate Folate intake

Sources

  1. Meat
  2. Dark green leafy vegetables
    1. Spinach
    2. Romaine lettuce
  3. Dry beans
  4. Peanuts
  5. Wheat germ
  6. Yeast
  7. Enriched whole cereal grains (140 ug/100 grams grain)

 

    1. Alcohol Abuse
    2. Elderly
    3. Vegan Diet
  1. Increased Folate utilization
    1. Pregnancy
    2. Malignancy
  2. Medications
    1. Oral Contraceptive Use
    2. Pyrimethamine (Daraprim)
    3. Triamterene
    4. Alcohol
    5. Biguanides
      1. Methotrexate
      2. Cholestyramine (Questran)
    6. Anticonvulsants
      1. Phenytoin (Dilantin)
      2. Primidone (Mysoline)
      3. Phenobarbital
      4. Valproic Acid (Depakote)
    7. Antibiotics
      1. Sulfasalazine (Azulfidine)
      2. Sulfamethoxazole
      3. Trimethoprim (e.g. Bactrim or Septra)
      4. Pentamidine
    8. Reverse transcriptase inhibitors (HIV Medications)
      1. Stavudine (Zerit)
      2. Lamivudine (Epivir)
      3. Zidovudine (Retrovir)
  3. Vitamin B12 Related Changes
    1. Gastric acid-blocking agents
      1. Proton Pump Inhibitors (e.g. Omeprazole)
      2. Histamine H2-receptor blockers (e.g. Ranitidine)
    2. Metformin (Glucophage)
    3. Colchicine
    4. Neomycin sulfate
    5. Nitrous oxide
    6. Para-aminosalicylic Acid
  1. Management
  1. Do not initiate Folate until B12 Deficiency ruled-out
    1. Folate supplementation masks B12 Deficiency
    2. Neurologic B12 Deficiency sequelae will progress
  2. Folic Acid 1-2 mg PO qd for 3 weeks or until resolved

For maintanence doses 4mg/d

Prophylaxis during pregnancy/lactation doses up to 1mg a day

Folic acid is available in (0.4,0.8 and 1 mg) PO, injection is reserved for pts with severely impaired GI obstruction

oh Charley

Charley Horse is the real deal. It’s AKA can be something more sophisticated like electrolyte imbalance on Monday through Friday though. There’s nothing like waking up from a deep sleep to excruciating pain, or sitting through bible study and writhing on the floor as your friends toss you a banana. Science narrows it down to a potassium and calcium deficiency, as those electrolytes are known to propagate neuromuscular activity.

Orange_and_cross_section

So unless you have been diagnosed with Vitamin D deficiency or perhaps a parathyroid deficiency some rehydration can help. Also depending on the frequency of your muscle spasms, check out you medication cabinet for any Side effect that you need to bring up to your doctor. Otherwise, Gatorade, oranges and 1 banana can help. Oh and if you live inside like I do then I would suggest a walk on the beach to collect some rays. There’s need for the emergency room, needles or radiation to diagnose, as there isn’t any true diagnosis of sorts.