Fundamentals and Clinical Applications of PNT

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1 실전정맥영양주사요법 PART I 김동환 MD., PhD.

2 정맥영양주사요법 급여적용 : 질환의범주영양학적문제로환자의생존과건강상태에문제가되는경우. 청구해야하는상황 비급여적용 : 질환이아닌건강목적단순피로, 권태, 성형, 미용, 비만, 탈모등건강보험영역외관리.

3 Laennec 비급여법적견해 만성질환의간기능장애개선 : 인정비급여 급여질환에대한비급여진료에해당.. : 진단되어진간기능질환에한하여급여범위에관계없이비급여주사치료가가능하다. ( 실손가능범위-급여질환치료범주 ) 인정비급여질환 ( 단순피로, 권태, 미용, 비만, 성형등 ) 현행의료법상의약품을허가사항 ( 적응증, 용법, 용량등 ) 외다른용법으로사용하더라도이는의사의처방권한내에있습니다. 물론의학적안전성, 유효성을근거로사용해야하는것이전제입니다

4 Laennec IV 해도될까요? 현행의료법상의약품을허가사항 ( 적응증, 용법용량등 ) 외다른용법으로사용하더라도이는 의사의처방권한내에있습니다. 물론의학적안전성, 유효성을근거로사용해야하는것이전제입니다. 러시아약전 정맥링거주사 : 약제 ( 앰플 5 개 ) 10 ml ( 태반가수분해물 560mg) 을 5% DW 용액또는생리식염수 ml에희석하고 시간동안정중주피정맥 (median cubital vein) 을통해투여한다. 매일주사하며, 치료과정은 2-3 주이다.

5 Key Approach : Chronic Stress & Chronic Inflammation 단순피로 권태 기능저하 노화 삶의질 PNT (Placenta Nutritional Therapy) P : Placenta Injection, Green Cross N : Nutrition, Injection & Supplements T : Therapy, Target & Systemic Injections

6 영양학적문제로꼭해결해야할것 3 가지 1. 최적의위장소화기계의건강 2. 건강한간기능 3. 건강한세포막 Diet Supplements Education P N T Injections IVNT Drugs Lecture

7 개원의에겐어려운기능의학검사 유기산검사 음식알레르기검사 (IgG) 모발중금속미네랄검사 혈중중금속검사 타액호르몬검사 기타영양소검사 일반혈액검사를이용한기능의학적분석 (MylsDr.com) HRV ( 자율신경스트레스검사 ) BIA ( 생체임피던스검사 ) 8 월 17 일강남성모강좌

8 Healthy Unhealthy 수치로객관화해주며연령별정상범위는그래프로확인가능함. TP 감소의미 VLF 감소 LF 감소 HF 감소 - 자율신경활성저하 - ANS 조절능력감소 - 내 / 외적인스트레스요인에대한부적절한대처능력감소 호르몬계체온조절산소부족 *5 분측정시임상적의미적다. - 체내에너지소실 (Loss of energy) - 피로 (Fatigue) - 수면부족, - 무기력 - 나른함 - 만성스트레스 - 노화 - 심장의전기적인안정도감소 - 기능성소화장애

9 SNS & PNS : 교감, 부교감신경의활성정도를상대적으로표현 ( 교감 ) ( 부교감 ) Healthy ( 교감 ) ( 부교감 ) Unhealthy

10 기본상담및검사 나이, 성별, 체중, 키, 허리둘레 병력및가족력 생활습관 현재불편사항 기대 생활습관수정코칭 기능의학검사권유 PNT plan

11 기본혈액검사를통한스크린 CBC D/C LFT and Kidney Panel Thyroid Function Test Lipid Panel 철분대사 : 철분, Ferritin 비타민 D : 25-OH cholecalciferol 미네랄 : Na, K, Ca, Cl, Mg, Zn Hgb A1C hscrp Fibrinogen Homocysteine 기타일반생화학검사 Vit D 저하 미네랄저하 장누수증후군 Oxidative Stress Subclinical Hypothyroidism 간, 신장기능장애 만성염증 당뇨 비타민 B 군저하 미네랄부족등..

12 Organix evaluation the 7 steps of on Organix evaluation: 1. Mitochondrial Function and Assessment 2. B-Complex Vitamin Markers 3. Methylation Pathway Markers 4. Neurotransmitters Metabolism Markers 5. Oxidative Damage and Antioxidant Markers 6. Detoxification Markers 7. Intestinal Dysbiosis Markers

15 Dihydrolipoate acid recycles the major cell antioxidants Vitamin C, Vitamin E, Glutathione, Thioredoxin and Ubiquinone

19 Vit B12 Vitamin B12 insufficiency is common, especially in people 55 or older, vegetarians, or anyone on acid blocking medication. MMA in urine to evaluate B12 need. Serum B12 has a low predictive value for actual vitamin B12 deficiency. Elevated MMA identifies B12 as insufficient, and as it turns out urine and serum MMA are very closely correlated.

23 Glycine ( 감초주사성분 ) Glycine, the simplest amino acid, is considered conditionally essential in man. Inadequate amounts can impair those functions that are glycine-dependent such as: production of collagen, elastin, porphyrins for hemoglobin and cytochrome P450s, bile salts, purine bases, and glutathione; for detoxification of benzoic acid; and methyl donation via the glycine cleavage system. That s a lot. The functional need for glycine can be reviewed in several urinary markers including pyroglutamate, benzoate, hippurate, and 2- methyl-hippurate.

26 혈중및모발중금속미네랄검사

27 기타기능의학검사 타액스트레스호르몬검사 필수지방산검사 혈중아미노산검사 Etc..

28 PNT 문진 1. 과거병력 1. 알레르기유무 약물, 음식, 금속, 환경, 등. 2. 수술기왕력 3. 만성질환유무 - 약물복용 2. 현재불편한모든것들 피로 / 스트레스 / 위장관불편감 / 수면장애 / 근긴장및통증 / 걱정, 불안, 우울 / 기타 3. 생활습관 : 식사 / 운동 / 잠 / 배설 / 활동 4. 나쁜습관 : 술 / 담배 / 운동부족 / 기타. 5. 건강식품섭취유무및내용

29 환자를알아야 Life-Style Guidance 를위한문진 식이습관 배설습관 수면습관 생각습관 운동습관 나쁜습관 음주습관 흡연습관 행동습관 ( 자세 ) 카페인섭취 사회관계

31 음식알레르기검사가필요한가?

34 Acid-Dependent Minerals That Require Adequate Stomach Acid to Enhance Intraluminal Absorption in the Small Intestine Chromium (Cr) Copper (Cu) Manganese (Mn) Selenidum (Se) Zinc (Zn) Enzymes ; Eating disorder Iron (Fe) Magnesium (Mg)- 300 Enzymes ; Heart Health. Molybdenum (Mo)

35 absorption of minerals The absorption of minerals is dependent on so many different factors, not the least of which is 1. age, 2. adequacy of stomach acid output, 3. balanced bowel flora, 4. lack of intestinal illnesses and parasites, 5. dietary fiber intake.

36 Body Organs and Tissues Affected By Toxic Levels of Minerals Aluminum (Al) Arsenic (As) Cadmium (Cd) Lead (Pb) Mercury (Hg) Stomach, Bones, Brain Cells (cellular metabolism) Renal Cortex of the Kidney, Heart, Blood Vessels to the Brain, Appetite and Smell Center of the Brain; Every Known Process in the Development of Cancer. Bone, Liver, Kidney, Pancreas, Heart, Brain, Nervous System Nervous System, Appetite and Pain Centers of the Brain, Immune System, Cell Membranes

37 Nutrients Protective Against the Effects of Toxic Elements Toxic Element Protective Nutrients Aluminum (Al) Arsenic (As) Cadmium (Cd) Possibly magnesium. None other. Selenium; Iodine; Calcium; Zinc; Vitamin C; Sulfur; Amino Acids (Found in garlic, hen's eggs, and beans) Zinc, Calcium, Vitamin C, Sulfur Amino Acids Lead (Pb) Zinc, Iron, Calcium, Vitamin C, Vitamin E, Sulfur Amino Acids Mercury (Hg) Selenium, Vitamin C, Pectin, Sulfur Amino Acids

38 Gut microbiota and the intrinsic and extrinsic factors that can affect its distribution and composition. Simrén M et al. Gut doi: /gutjnl Copyright BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.

Plot chart of currently available strategies for modifying gut microbiota aiming to demonstrate the relationship between the effectiveness and invasiveness/safety of

39 Plot chart of currently available strategies for modifying gut microbiota aiming to demonstrate the relationship between the effectiveness and invasiveness/safety of the proposed approach. Simrén M et al. Gut doi: /gutjnl Copyright BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.

40 유산균이왜필요해?

41 간에생기는일 : 염증

44 피로할때해줄수있는

45 피로 하면생각해봐야! 우울증, 걱정, 불안 빈혈 갑상선질환 수면장애 감염 습관성음주 미토콘드리아기능장애 갱년기 과도한육체노동 염증성장질환 B12 부족 영양결핍 전해질장애 노화 약물부작용

46 부신피로증상들알아보기 Low energy/excessive fatigue/easily overwhelmed Dizziness upon standing Inflammatory conditions (arthritis, bursitis) Nervousness, anxiety, depression, insomnia Cold hands and feet Hormonal imbalances (thyroid problems) Low back pain, sore muscles, headaches Low/high blood pressure Poor concentration/memory problems Excessive perspiration and urination Cravings: sugar, salt, coffee or other stimulants Digestive problems, ulcers Weight gain Recurrent colds or infections (low immune system) Allergies (food/environmental)

47 Cortisol and Thyroid 80% of people with adrenal fatigue will also have low thyroid function TREAT THE ADRENALS FIRST!!!!

48 Insulin Resistance Increased stress (high cortisol)/diet high in refined carbohydrates = increased blood sugars Increased blood sugar = increased insulin Tissue resistance with prolonged insulin release High cortisol = more fat cells around the abdomen Difficulty losing weight METABOLIC SYNDROME

49 Cortisol and Melatonin High Cortisol = Low Melatonin Melatonin will compete with Cortisol for receptor sites and therefore will counter the stimulating effect of cortisol in the night Cortisol is the highest in the morning and then gradually decreases as the day progresses = lower in the evening In Adrenal Fatigue, the opposite is true : Cortisol is low in the morning and high in the evening resulting in sleep disturbances and insomnia

50 Stress and Inflammation Inflammation is a normal process of the human body Cortisol has potent anti-inflammatory properties In small amounts, cortisol is essential in tissue repair and controlling inflammation and excess immune cell production Increased cortisol = slows down antiinflammatory messengers = more inflammation In adrenal fatigue, immune complexes circulate in excess leading to the immune system attacking itself (RA, Lupus, Hashimoto s etc.)

51 Important Supplements for Restoring Adrenal Health Proper nutrition as well as vitamins and minerals are necessary to make the adrenal hormones Magnesium important for energy production of every cell in your body and for adrenal gland recovery Vitamin C is used in all areas of the adrenal cortex, is an adrenal anti-oxidant, more vitamin c is used as more cortisol is made B complex - help support the nervous system Pantothenic acid (B5) important for energy production, converts glucose into energy, will help support adrenal function without over stimulating it

52 Important Supplements for Restoring Adrenal Health Vitamin B6 also a cofactor for enzyme pathways GABA is an inhibitory neurotransmitter and works like a brake during times of runaway stress. Controls brain excitability. Zinc essential for the immune system and adrenal health. Omega 3s: EPA and DHA lowers inflammation, supports cardiovascular health, brain and nervous system Adequate fibre! Better bowel elimination helps with detoxification, as adrenal health is restored the liver is required to filter more. At least 45 grms of fibre daily! In the form of: psyllium, ground flax seeds, legumes, hemp hearts, and oat bran.

53 Vitamins B5, B6, B12 These important B vitamins play an important role in cell metabolism. Improving your metabolic pathways boosts your energy levels and is a great way to reduce the fatigue often felt during AFS. B5 helps to produce co-enzyme A, which contributes to cellular respiration and the breakdown of fats, proteins and carbohydrates. B6 acts in several of the pathways that are used to create adrenal hormones. And B12 helps with energy production, cell repair and the maintenance of our red blood cells. The amounts that you need of each are quite different, for example you should be aiming for 1000mg of B5, 50mg of B6 and 100mcg of B12 as a good starting dose.

54 Pantothenic Acid: Vopr Pitan Jul-Aug;(4):51-4. Adrenal cortex functional activity in pantothenate deficiency and the administration of the vitamin or its derivatives Tarasov IuA, Sheibak VM, Moiseenok AG. Study of the corticosteroid content in the adrenals and blood of rats under pantothenate deficiency has demonstrated a decrease in adrenocortical function. A single administration of pantothenate in a dose of 3.3 mg/kg reduced the influence of hypovitaminosis on the adrenals.

55 The Effects of Pantothenic Acid Deficiency on the Secretion of Corticosteroids by the Albino Rat Endocrinology 1958; 62: 565 Longwell et al. Lovelace Foundation, Albuquerque, NM. Pantothenic Acid deficiency was shown to significantly reduce the production of corticosterone - the predominant steroid in the rat adrenal. Much of the literature on pantothenic acid in adrenal fatigue is found in Japanese literature.

56 Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla Endocr Res 2004 Nov;30(4):871-5 Department of Endocrinology, Diabetes, Rheumatology, Heinrich-Heine University, Duesseldorf, Germany. The adrenal gland is among the organs with the highest concentration of vitamin C in the body. Interestingly, both the adrenal cortex and the medulla accumulate such high levels of ascorbate. Ascorbic acid is a cofactor required both in catecholamine biosynthesis and in adrenal steroidogenesis.. Mutant mice lacking the plasma membrane ascorbic acid transporter (SVCT2) have severely reduced tissue levels of ascorbic acid and die soon after birth. There is a significant decrease of tissue catecholamine levels in the adrenals. On the ultrastructural level, adrenal chromaffin cells in SVCT2 null mice show depletion of catecholamine storage vesicles, signs of apoptosis, and increased glycogen storage. Decreased plasma levels of corticosterone and altered morphology of mitochondrial membranes indicate additional effects of the deficiency on adrenal cortical function.

57 Suppression of steroidogenesis and activator protein-1 transcription factor activity in rat adrenals by vitamin E deficiency-induced chronic oxidative stress. J Nutr Biochem Apr;15(4): Abidi P et al. Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA Plasma, liver, and adrenal tissues from vitamin E-deficient animals had negligible levels of this vitamin and showed high susceptibility to in vitro lipid peroxidation. Synthesis and secretion of corticosterone in response to corticotropin (ACTH), dibutyryl-camp, or 20alpha-hydroxycholesterol in vitro was significantly reduced in adrenocortical cells prepared cells from rats deficient in vitamin E.

58 Vitamin A Important cofactor in steroid production

62 정맥영양주사요법워크샵 Donghwan Kim, M.D., Ph.D. GC i-med Clinic

63 정맥영양주사는이건아닙니다. Cure Replacement for : Diet Exercise Oral Nutrition Need for Everyone

64 Medical nutrition therapy (MNT)

65 최고최선의결과를위해서 Combined Therapies Combined Disciplines Monitor lab and look for Cellular Changes

66 정맥영양주사시 ABC 부작용모니터링 Cramps Dizziness Sweaty Nausea Disorientation ABC 기본준비물 Epi 1:1000 O 2 Mask & Cannula Laryngoscope with endotracheal tubes Calcium DW 50%

67 정맥영양주사가능한사용범주 피로 해독 수술전후 급성 URI care 통증 알레르기질환 항노화 지구력향상 스포츠 영양결핍 플라세보

68 정맥영양주사실운영 : 필요한사람 Super I.V. Skills Personable Educator Caring Organized

69 영양주사제의고려사항 내용성분과작용 일반적인효과및부작용 오스몰 혼합할수액선택 혼합할때예상되는문제들

70 Chemical irritation causes Loss of venous endothelial cells, Inflammatory cell infiltration, Edema Thrombus Proximal and distal to the catheter tip

71 ph ph: Plasma ph is tightly regulated normally between 7.35 and The administration of compounds with widely variant ph values may impact the overall normal physiologic acid-base balance and result in pain and distress upon injection. Acidic (<4) and alkaline (>11) solutions should be avoided and if required, should be administered in small overall volumes. Solutions compounded within a ph range of 6.5 to 8.0 are generally well tolerated in continuous intravenous infusions while solutions in the ph range of 5-9 can be tolerated for a shorter duration.

72 Sterility and Pyrogenicity Parenteral (IV, SC, IM, IP) administered compounds should be sterile and pyrogen-free. Sterility can be accomplished by steam autoclaving, dry heat sterilization, irradiation, sterile filtration, etc. dependent upon the compound and the diluent used. Pyrogens can be avoided by using purified and characterized compounds and diluents in preparation of the final drug. Unlike osmolality and ph, sterility is critical for parenteral administered drugs regardless of the route of administration or volume of drug being administered.

73 금기사항 어떤성분이든알레르기반응이있는경우 Ascorbate from corn Corn antigen Glutathion recombinant DNA technology Anaphylaxix from B12 RBC G6PD deficiency Hemolysis NAC Heavy Metals level Redistribution of metals to the CNS

75 product 오스몰 (mosm/ml) ph Laennec Megagreen Mg 10% B B B HishiphagenC Fursultamin N/S 0.9% % 포도당

76 오스몰관련가이드라인 mosm/ml : 큰정맥 중간정맥 작은정맥 IV push IV drip 작은정맥 : 1-4mm ( 손, 두피, 발목부위정맥 ) 중간정맥 : 4-10mm 큰정맥 : 10+ mm (Medial, Subclavian)

77 수액선택 Sterile Water 5% DW To avoid highly ionized solution (phosphatidyl choline, Lipoic Acid) Normal Saline Used for hypotonic solutions (MTE, H 2 O 2 )

78 추가고려사항들 차가운수액정주는불편감을야기할수있다. 정맥주사전에미리혼합하여둔수액은각각의성분의작용이변질될가능성이있다. 금기증을항상기억해야한다. Vit B12 는 SQ, IM 이더효과적이다. Glutathion 과리포익산은따로정주한다. 마그네슘정주는너무빠르게하면혈압저하와뜨거운느낌, 실신이발생할수있다. 두통이발생시황과민반응인지고려해야한다. 저혈당을예방하기위해정주 1-3 시간전에식사를하는것이좋다. ( 특히 Vit C 정주시 ) 장시간주사하는경우빛을차단하는수액백과수액세트를사용하는것이좋다. 나트륨내용물로 CHF 환자같은경우에합병증을야기할수있다.

79 통증해결하기 Fluid 양을늘린다. Hydration 을시킨다. ( 생수마시기 ) Heating Pad Gentle pressure or rubbing Lidocaine 3-5cc Bicarbonate 10cc Change I.V. site 예민한환자경우 : 정주속도를느리게한다. 가능한큰혈관을확보한다. 가는바늘을사용한다. (25G)

80 Anaphylactic Reaction 이일어날까? 즉각놓고있던정맥주사를중단한다. 반대편팔에 Epi 1: ml 를피하주사한다. 정주수액을제거하고생리식염수로대체한다. 매 5 분간격으로 Vital monitoring 한다. ABC s

81 Basic IVNT( Intra-Venous Nutritional Therapy) Protocols 1. Myers Cocktail Protocol 일반적으로임상적용에있어칼슘은사용하지않는경향이있습니다. 각제품에따라혼합된성분, 농도및용량이매우다양하고적용대상자의상태에따라많은변화가발생할수있으므로, 질환별임상적용에있어, 성분, 농도및용량을정확히확인후사용하시기바라며, 상기자료는단지참고자료로만활용하시기바랍니다. 2. Riordan Protocol 3. Vit C Protocol 4. PNT Protocol 5. 꼭주의하여야할사항 1) 혼합된수액의농도 (Osmolality) 를계산하고수액을선택하여야하며, 절대로저장액수액이되어선안됩니다. 2) 모든수액또는주사제는과민성이있을수있으니처음주사시에는과민성반응을꼭잘살펴야합니다. 3) 수액은미리혼합하시지마시고, 주사직전혼합이원칙이며, 주사전에혼합수액에추출물의유무를확인하는습관이중요합니다. 4) 주사를통한부작용과합병증에대해알고있어야하며, 가능한그런일이발생하지않도록최선을다해야합니다.

82 P : Option Vit C 500mg/ml 마이어스 IV push Laennec 2-5@, Hishiphagen 4cc 10% MgSO4 4cc 10% Calcium Gluconate 2cc Hydroxocobalamin Vit B6 Vit B5 Sterile Water 정주속도 : 5 분이상 25 G butterfly needle 1mg 100mg 250mg 20cc

83 질환 영양 (ml) Myers Cocktail Protocol MTE-5 : zinc 1 mg, copper 0.4 mg, chromium 4 mcg, selenium20 mcg, and manganese 0.1 mg. C 222mg B5 250mg B6 100mg Vitamins B12 1mg B-complex 100 B1,B3 100mg/B2,5,6 2mg 20%MgCl Minerals 10% Calcium Gluconate 일반적인경우 6(4-20) (2-5) 2(1-3) 천식 (10yr old) 편두통 섬유근통 우울증 심혈관질환 MTE-5 0.2ml 감기 (URI) 만성부비동염 알레지성비염 만성두드러기 운동경기력향상 Intravenous Nutrient Therapy: the Myers Cocktail by Alan R. Gaby, MD

88 Vit C 25g Infusion Vit C 500mg/ml ( 메가그린 ) 50ml 10% MgSO4 ( 메가네슘 ) 8ml Vit B 5 Vit B 6 Hydroxocobalamin 1ml Multi-vit B Calcium Gluconate 10% 10cc ( Vit C induced Hypocalcemia) ADD the nutrients to ml of Sterile Water. Administer over 1hour.

89 PNT Placenta : human Placenta Extract (Laennec, Green-Cross) Nutritional : Vitamin, Mineral & Herbs (IVNT, IM, Supplements) Therapy : Target & Systemic Therapeutic Injection (IM & IVNT) PNT- HAL Protocol PNT- Liver Protocol PNT-QOL Protocol PNT-Basic Protocols Laennec 5@ Laennec Laennec 1. Laennec SQ Abdomen : 1-8@ Vit. C 10g Hishiphagen Amino-Acid 2. Laennec IM Deltoid, Gluteus, ParaVertebral m., etc : 1-8@ 10% MgSO4 10ml Glutathione Vit. C 3. Laennec + Myers Cocktail Vit. B5 1@-3@ Lipoic Acid Zn 4. Combination Vit. B6 1@-3@ Vit. B5 Vit. B-Complex 5. Add the Other Protocols Vit. B12 1@ Vit. B6 10% MgSO4 Fursulthiamine 1@ Trace Minerals Hishiphagen 1-2@ Gingko-Biloba 1@

90 히시파겐 ( 감초주사 )

91 글루타치온 IV push 용량 mg 5-10ml Sterile Water 에혼합정주 Push over 3-5minutes 주사간격 : 2-3 회 / 주 영양요법 : 아보카도, 포도, 감자, 딸기, 워터멜론 NAC BCAA 로즈마리

92 Red PNT Protocol [Common Cold] 구분기대효과 Protocol 오스몰 (mos/ml) ph 오스몰희석배수 비고 Red PNT1 기침, 콧물 N/S 250ml+ 라이넥 2A+ 메가그린 2V + 메가네슘 10ml x3 Red PNT1 기침, 콧물 5% 포도당 250ml+ 라이넥 2A+ 메가그린 2V + 메가네슘 10ml x3 Red PNT2 + 인후통 N/S Red PNT1 + 히시파겐씨주 1A x3 Red PNT2 + 인후통 5% 포도당 N/S Red PNT1 + 히시파겐씨주 1A 1, x3 Red PNT3 + 근육통 N/S Red PNT2 (250ml) + 푸르설타민 1A x3 Red PNT3 + 근육통 5% 포도당 Red PNT2 (250ml) + 푸르설타민 1A 1, x3

93 Orange PNT Protocol [ 음주해독 ] 구분기대효과 Protocol 오스몰 (mos/ml) ph 오스몰희석배수 비고 Orange PNT1 간기능회복신경세포회복 N/S 250ml+ 라이넥 3A+ 메가그린 1V + 메가네슘 5ml+B5 1A+B6 1A + 히시파겐씨 1A+ 푸르설타민 1A X3 Orange PNT1 간기능회복신경세포회복 5% 포도당 250ml+ 라이넥 3A+ 메가그린 1V + 메가네슘 5ml+B5 1A+B6 1A + 히시파겐씨 1A+ 푸르설타민 1A x3

94 Green PNT Protocol [Liver Function / Hepatitis / Detox ] < 적용 LAB> 간기능검사 ( 다음장참조 ) 타액호르몬 / 중금속미네랄검사 구분기대효과 Protocol 오스몰 (mos/ml) ph 오스몰희석배수 비고 Green PNT1 Liver Function / Hepatitis N/S 250ml+ 라이넥 5A+ 메가그린 1V + 메가네슘 5ml+B5 1A+B6 1A +B12 1A + 히시파겐씨 2A+ 푸르설타민 1A x3 Green PNT1 Liver Function / Hepatitis 5% 포도당 250ml+ 라이넥 5A+ 메가그린 1V + 메가네슘 5ml+B5 1A+B6 1A +B12 1A + 히시파겐씨 2A+ 푸르설타민 1A x3

95 Blue PNT Protocol [Fatigue / Stress / 화병 / 우울증 ] < 적용 LAB> HRV / 유기산 / 타액호르몬검사 구분기대효과 Protocol 오스몰 (mos/ml) ph 오스몰희석배수 비고 Blue PNT1 Fatigue (Stress/ 화병 ) N/S 250ml+ 라이넥 3A+ 메가그린 1V + 메가네슘 5ml+B5 2A+B6 2A B12 1A+ 히시파겐씨 1A X3 Blue PNT1 Fatigue (Stress/ 화병 ) 5% 포도당 250ml+ 라이넥 3A+ 메가그린 1V + 메가네슘 5ml+B5 2A+B6 2A B12 1A+ 히시파겐씨 1A x3

96 Migraine and Dysphagia Protocol The Migraine and Dysphagia Protocol contains Vitamin B6 and Magnesium and is pushed through a syringe over the course of 10 minutes. It is used to treat: Mild migraines Moderate migraines Severe migraines Tension headaches Regurgitation Dysphagia (difficulty swallowing)

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106 실전정맥영양주사실습 Donghwan Kim, M.D., Ph.D. GC i-med Clinic

107 준비 병원 1. 사람 2. 장소 3. 준비물 4. 필요한장비 5. 주의점 6. 반복연습 7. 세심한관리 의사 영양주사치료가왜필요한가? Who? When? What? How much? Combination? Education / Healing

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract