Chemotherapy is the main method for the treatment of acute leukemia. It can be divided into two stages: remission induction and maintenance treatment, during which intensive treatment, consolidation treatment and central nervous system preventive treatment can be added. Remission induction is a combination of high-dose multiple drugs and intense chemotherapy in order to quickly kill leukemia cells in large quantities, control the condition, and achieve complete remission, laying a solid foundation for future treatment. The so-called complete remission means that the symptoms and signs of leukemia disappear completely, and the blood and bone marrow picture basically return to normal. At the end of treatment of acute leukemia, the number of leukemia cells in the body is estimated to be 5×1010~13. There are a considerable number of leukemia cells, estimated to be less than 108 to 109, and there may still be infiltration of leukemia cells in some hidden places outside the marrow. A series of low-dose and milder treatment programs for maintenance treatment are carried out for a longer period of time. The purpose is to consolidate the complete remission obtained by remission induction and enable the patient to maintain this “disease-free” state for a long time and survive. Reach a cure. Consolidation treatment is after maintenance treatment. Before the maintenance treatment, if the patient permits, repeat the remission induction program. Intensive treatment is to repeat the original remission induction program in the middle of several courses of maintenance treatment. Central nervous system preventive treatment should be carried out immediately after induction therapy appears to be relieved to avoid and reduce the occurrence of central nervous system leukemia. A complete treatment plan should follow the above principles. Treatment of acute lymphoblastic leukemia ①Remission induction therapy: The commonly used chemotherapy regimen for the treatment of ALL is the VP regimen, which is based on the VP regimen and then combined with DRN (daunorubicin), ADM (adriamycin), Ara-c, L-ASP (L-asparaginase) and 6-MP and other drugs constitute many effective multi-drug combinations. The rate of CR (complete remission) in children with initial treatment can reach 90% to 95%. Adults can also reach 80% to 90%. The multi-drug combination program is mainly used for the treatment of refractory and relapsed cases. The commonly used programs are shown in the table. Remission induction regimen for acute lymphoblastic leukemia chemotherapy regimen Dosage method VP regimen VCR 2 mg intravenously, PDN 60 mg orally once a week on the first day, DVP regimen DRN 1 mg/kg intravenously on the first day, 1 week per week The second 4-6 weeks is a course of VCR 1.5mg/m2 intravenous injection, on the first day, PDN40mg/m2 is taken orally once a week, and the POMP plan PDN60mg/d is taken orally for 5 days as a course of VCR2mg intravenously. MTX 30mg intravenously on day 1, 6-MP100mg oral VDCP regimen DRN40mg/m2·d intravenously on day 2, 5, and VCR 2mg intravenously on day 1, 2, 3, 15, 16, and 17 for three weeks, first CTX0.4-0.8/m2 intravenous injection on days 8, 15, and 21, PDN40-60mg/m2·d orally on day 1, 15 and after 1-14 days, reduced dose of DVP+ASP plan VCR 2mg intravenously on day 1. , Once a week for bone marrow examination on the 15th day, if there are still leukemia cells, then use DRN50mg/m2, 4 weeks is a course of DRN50mg/m2 intravenous injection, the first 1, 2, 3 days PDN 60mg/m2 divided oral, first 1- L-ASP600u/m2 intravenously on 28 days, 17-28 days. Note: VP and DVP programs are applicable to children’s cases. ②Maintenance treatment: After the CR is achieved with the above scheme, the original scheme should be used to consolidate the effect. Those who use VP and VDP programs should continue for another 2 to 3 weeks. Those who use POMP programs can use two more courses. During remission, 6-MP100mg/d was taken orally for 7 consecutive days, followed by intravenous injection of CTX400mg. Intermittently for 7 days and then MTXl5mg, intravenously or orally, on the first 1, 5, and 9 days. Repeat the above treatments in turn after 3 days of intermission. ③Treatment of recurrence: You can continue to use the VP regimen or Ara-C5-10mg, intravenously once a day, 4 times in total, or DRN1mg/kg·d, intravenously, for 4 days.
Potassium ion (K+) is one of the most important cations in the body. The total amount of potassium in a normal human body is about 50mmol/kg body weight, 98% of which is located in the cell, and the potassium in the extracellular fluid only accounts for 2% of the total potassium (about 60mmol , Of which about 1/4 is located in the plasma), just because the extracellular fluid does not contain much potassium, it is not advisable to add potassium too quickly, otherwise it may cause a lot of increase in blood potassium within a period of time, which will cause death. Normal human blood potassium is between 3.5~5.5mmol/L. Clinical manifestations of hypokalemia. Blood potassium concentration lower than 3.5mmol/L indicates hypokalemia, 3.0-3.5mmol/L is mild; 2.5-3.0mmol/L is moderate; 2.5mmol/L or less is severely low Potassemia. Common causes of hypokalemia include: long-term undereating, application of diuretics such as furosemide, long-term rehydration without potassium, vomiting, continuous gastrointestinal decompression, and massive infusion of glucose and insulin. When encountering some patients with consciousness disorder, weakness of limbs, and weakness of respiratory muscles, not only should they consider neurological problems, but also whether there is a possibility of hypokalemia, it is recommended to check electrolytes. Generally speaking, hypokalemia can be initially diagnosed based on medical history and clinical manifestations, and the diagnosis depends on the specific measurement of serum potassium. For patients with hypokalemia, do not neglect the ECG (into the above) examination, but not every patient has ECG changes, so the diagnosis of hypokalemia should not be based on abnormal ECG alone. Once the patient has frequent premature beats or even supraventricular tachycardia, we must consider whether there is a possibility of hypokalemia. Check blood potassium to understand the situation, and secondly, we can prepare for the use of amiodarone, cedilan, etc. ready. The treatment of hypokalemia is mainly to remove the cause of hypokalemia, and then to supplement potassium. The application value of calculating how much potassium is lacking and how much potassium is supplemented according to the formula is of little application value. Few people in clinic will make potassium supplements rigidly by calculation. They all roughly judge the degree of potassium deficiency first, and then observe while supplementing, if necessary, several times a day. Check blood potassium, usually 3-5 days to complete. Two principles of potassium supplementation: can be taken orally as much as possible, see urine potassium supplementation. 1g potassium chloride contains 13.4mmol/L potassium, which is calculated, it is useful to remember it. The daily physiological requirement of potassium for a normal person is about 3g, which is about 5.6g for potassium chloride. Patients with mild potassium deficiency in general wards should be encouraged to eat foods that contain more potassium, such as oranges, bananas, coffee, etc., and they can be taken orally as much as possible. For example, oral 10% potassium chloride oral solution 10mltid can be supplemented with 3g chloride a day Potassium, plus the fact that patients can eat on their own, can basically make up for it. But potassium liquid tastes bad and bitter, so you can add some orange juice or something. If potassium deficiency is a little more important, you can increase the oral dose, such as 20ml tid (total 6g potassium chloride). If the patient cannot take it orally, or if hypokalemia has caused arrhythmia, limb flaccidity, etc., intravenous potassium supplementation is required. There are many precautions for intravenous potassium supplementation. In general wards, intravenous potassium supplementation is mostly peripheral vein, which limits the concentration and speed of potassium supplementation. For a long time, “Surgery” generally recommended that the potassium content per liter of intravenous potassium supplementation should not exceed 40mmol (equivalent to 3g potassium chloride), which is the origin of not more than 0.3%, and the potassium input should be 20mmol/h the following. If the patient should not take too much fluid, the content can be reduced accordingly. For example, 250ml of fluid with 0.75g potassium chloride (10% potassium chloride injection 7.5ml), the concentration is still 0.3%, but the potassium supplement is very small, only 0.75g. At this time, a central venous pump may be used for potassium supplementation. It is worth noting that in ICU, anesthesiology and other departments, they are directly pumped with 10% potassium chloride needle 30ml+20ml normal saline. At this time, the concentration far exceeds the above 0.3% range, reaching an amazing 6%, is this feasible? feasible! It is currently believed that the more important factor for potassium supplementation is the amount of potassium that enters the body per unit time, rather than the concentration on the potassium supplement solution. In other words, speed is more critical than concentration. In the above pumping combination, for example, the speed is 10ml/h, then it should be 0.6g potassium chloride/h, 1g potassium chloride=13.4mmol potassium, 0.6g potassium chloride is about 8mmol potassium, which is still significant Lower than the “Surgery” believes that the input potassium should be below 20mmol/h, which does not violate the principle. 20mmol potassium is about 1.5g potassium chloride, from this
[Patient] Doctor, I am only 40 years old. I have had three symptoms of epilepsy in just three months. And I usually smoke, no hypertension, diabetes, and family members have never persuaded me, people who have heard of epilepsy can not drink alcohol, what is the cause of my old guilty illness?【Doctor】 Don’t worry, I will check the specific reasons for this hospitalization to prevent the occurrence of epilepsy symptoms in the future, so as not to cause serious sequelae. Free consultation for epilepsy, online answer by famous doctors, click here to ask if epilepsy is not cured, what’s going on? What blame do you not pay attention to? Including diet, daily life, exercise, these aspects should be extra careful. It usually takes 10-15 days to observe, and quickly give stable intravenous bolus injection in an emergency, control the attack as soon as possible, and can continue intravenous administration if necessary. This should be considered as the condition of epilepsy deepening, preparation for surgical treatment, and combined use. It is necessary to consider whether there are factors such as fatigue, infection, and uncontrollable mood. If the individual differences are large, there are several reasons for the recurrence of epilepsy. Epilepsy is not cured, what’s going on? Why do you blame you for not paying attention? Including diet, daily life, exercise, these aspects should be extra careful. It usually takes 10-15 days to observe, and quickly give stable intravenous bolus injection in an emergency, control the attack as soon as possible, and can continue intravenous administration if necessary. This should be considered as the condition of epilepsy deepening, preparation for surgical treatment, and combined use. It is necessary to consider whether there are factors such as fatigue, infection, and uncontrollable mood. If the individual differences are large, there are several reasons for the recurrence of epilepsy. Extended reading: Guiyang Hospital for Epilepsy suffers from epilepsy injuries everywhere. As a common brain and nervous system disease, patients suffer from low self-esteem. This kind of disease is still relatively harmful and very complicated. Choose a plan that suits you and go to a regular hospital for diagnosis. Lack of sufficient understanding and sufficient mental preparation, eager to achieve success, in fact, this is just a mistake in thought, Qi and blood functions focus on the spleen and kidney, everything is normal in the body. I don’t pay attention to it in my mind, and I must have the overall ability to deal with the concept of epilepsy rehabilitation and be able to communicate well with the doctor.