Vitamin E as supplements NOT recommended routinely 减少维他命E的服用

Quite a number of patients are visiting the pharmacy for vitamin E supplements. I personally recommend against stand-along supplementation of vitamin E. Reasons are below,

vitamin E is an antioxidant that was marketed towards general health and boosting immune function many years ago. The marketing was based on the theory that antioxidants decrease free radicals in the body thus preventing cellular damage. Evidence did not exist in full strength then on the safety of supplementation. Multiple studies looking at such concern was published around 2004-2005, suggesting that supplementing with vitamin E can possibly cause HARM with NO BENEFIT in cardiovascular protection. It is suggested that vitamin E supplementation if necessay must be kept under 400IU daily and an intake of 400IU or greater has been shown to increase risk of heart failure minimally in high risk patients and increase all-cause-mortality with dose >400IU/day.

In addition, vitamin E has been noted to increase bleeding tendency in patients taking NSAIDs, Warfarin, ASA or other blood thinning products. It is suggested to limit supplementation to 200IU if necessary or discontinue supplementation if vitamin E is not necessary.

Vitamin E:
sources: nuts, seeds, vegetable oils
daily requirement ~22.4IU from natural sources daily for general population (value may vary with references)
Usual commercially available products, 200IU and 400IU from natural or synthetic sources

虫咬，野外植物过敏现象 - bug bites and plant contact allergy

虫咬或被植物蛰了过后，

1. 用水和肥皂洗净
2. 可以考虑用上敷药品 - Astringents, Oatmeal baths (Aveeno), Calamine Lotion，此类产品可以使皮肤舒服一些，止痒，晾干。
3. OTC非处方 hydrocortisone 也可以使用，但效果并没有处方类药品理想。如果情况不严重，不需要用hydrocortisone, 情况严重的话，建议见医生开处方类上敷皮质类固醇。
4. 口服过敏药效果未必理想，应为痒的感觉不完全是由于histamine release. 口服过敏药效果平平
5. 上敷过敏药，麻醉药（止痛药）以及抗生素也不建议，应为会刺激皮肤。

hydrocortisone和其他上敷皮质类固醇需1-2日才能见效，保留此类药为中等-严重蚊虫叮咬现象。

Hypoglycemia

These has been a lot of talk about treating hypoglycemia/low blood sugar,

Remain calm, Suggested treatment include - 15g of simple sugar (glucose or table sugar, etc), use 20g of simple sugar to correct severe hypoglycemia. This is about 3-4 glucose tablets, 5-6 hard candy and 120mL of REGULAR soda.

Suggest retesting 15min after a hypoglycemia episode,

and suggest a small meal after blood sugar has been corrected.