[부천재활병원]뇌졸중의 원인중 하나인 당뇨! 약물치료의 선택은?

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none;" alt="스티커 이미지" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fstorep-phinf.pstatic.net%2Flinebiz21_01%2Foriginal_12.png%3Ftype%3Dp50_50"> </font></u></a></div></div> </div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"><p class="se_textarea"><span style="color: black;"><br></span><span style="color: black;">노인 당뇨환자의 약물 치료</span><span style="color: black;">:: </span><span style="color: red;">원칙은 인슐린 사용</span><span style="color: black;">입니다</span><span style="color: black;">. </span><span style="color: black;">사용이 곤란한 경우에 한하여 약물치료를 권합니다</span><span style="color: black;">.</span> <span style="color: black;">약제 선택은 언제나 어렵습니다</span><span style="color: black;">. </span><span style="color: black;">아래의 설명들을 보시면 드시지 말라 하는것과 같은 느낌을 줍니다</span><span style="color: black;">. </span><span style="color: black;">하지만 의료진이 </span> <span style="color: black;">환자분들의 상황과 건강을 고려한 처방을 주실 것이기 때문에 너무 염려하지 </span><span style="color: black;">않으셔도</span><span style="color: black;"> 됩니다</span><span style="color: black;">. </span><span style="color: black;">노인에게서 </span> <span style="color: black;">불규칙한 식사</span><span style="color: black;">, </span><span style="color: black;">고혈압</span><span style="color: black;">, </span><span style="color: black;">심장과 뇌혈관 질환</span><span style="color: black;">,</span><span style="color: black;"> </span><span style="color: black;">만성 폐질환</span><span style="color: black;">, </span><span style="color: black;">관절염 등으로 여러 약물들을 복용하시는 경우가 많고 그</span> <span style="color: black;">약물들의 상호 작용 등으로 </span><span style="color: black;">저혈당이</span><span style="color: black;"> 발생하는 경우가 흔합니다</span><span style="color: black;">. </span><span style="color: black;">따라서 각 약물들을 살펴보고 본인에게 맞는 기준이</span> <span style="color: black;">있는지 관심을 가져 보시는 것이 현명하다 생각합니다</span><span style="color: black;">.<br></span><span style="color: black;"></span></p></div></div></div></div></div></div><div class="se_component se_image default"><div class="se_sectionArea se_align-extend"><div class="se_editArea"><div class="se_viewArea"><a class="se_mediaArea __se_image_link __se_link" href="https://blog.naver.com/PostView.nhn?blogId=bch1588&logNo=221280854690&categoryNo=10&parentCategoryNo=0&viewDate=&currentPage=1&postListTopCurrentPage=1&from=postList&userTopListOpen=true&userTopListCount=30&userTopListManageOpen=false&userTopListCurrentPage=1#" data-linktype="img" data-linkdata='{"imgId" : "SEDOC-1527144790849-1990419019_image_2_img", "src" : "https://postfiles.pstatic.net/MjAxODA1MjFfMTM3/MDAxNTI2ODg4NTE2MTg0.QR_wT_gSwgnqubCaCDsFhrGXZgU8Ai9ZOfMV8D6_1vwg.Hy-3R2h-RHlgq_-WMZ7ksT7AGBCqg5qe5YVQvK3O-vsg.PNG.bch1588/image.png", "linkUse" : "false", "link" : ""}'><img width="763" height="296" class="se_mediaImage __se_img_el" id="SEDOC-1527144790849-1990419019_image_2_img" alt="" 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href="https://blog.naver.com/PostView.nhn?blogId=bch1588&logNo=221280854690&categoryNo=10&parentCategoryNo=0&viewDate=&currentPage=1&postListTopCurrentPage=1&from=postList&userTopListOpen=true&userTopListCount=30&userTopListManageOpen=false&userTopListCurrentPage=1#" data-linktype="img" data-linkdata='{"imgId" : "SEDOC-1527144790849-1990419019_image_3_img", "src" : "https://postfiles.pstatic.net/MjAxODA1MjRfMTAw/MDAxNTI3MTQ0NzgwMzU5.5dQiukoT8MYsThJvSi11EbsA4nEk5iQ6m4E5rUYjtKgg.XMhgdk9Hjhf3kzgM4Rll2VYJNDieqjIMCTrybWEADSMg.PNG.bch1588/image.png", "linkUse" : "false", "link" : ""}'><u><font color="#0066cc"><img width="917" height="488" class="se_mediaImage __se_img_el" id="SEDOC-1527144790849-1990419019_image_3_img" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fpostfiles.pstatic.net%2FMjAxODA1MjRfMTAw%2FMDAxNTI3MTQ0NzgwMzU5.5dQiukoT8MYsThJvSi11EbsA4nEk5iQ6m4E5rUYjtKgg.XMhgdk9Hjhf3kzgM4Rll2VYJNDieqjIMCTrybWEADSMg.PNG.bch1588%2Fimage.png%3Ftype%3Dw773" data-lazy-src="" data-width="917" data-height="488" data-attachment-id="IY-vb_D7Yrs5sNn4En6dlWm5FORk"> </font></u></a></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"><p class="se_textarea"><font color="#0066cc"><br></font></p></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"><p class="se_textarea"><br><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>1.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>설폰요소제</b></span><br><span style="color: black;">설폰</span><span style="color: black;"> 요소제는 많은 임상경험의 축적으로 안정성과 효과 입증되어 있어 </span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>투여가 간편</b></span><span style="color: black;">하다는 장점이 있지만 노인 당뇨환자에서는 </span><span style="color: black;"></span><span style="color: black;"></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>저혈당</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 위험이 높은 약물</b></span><span style="color: black;">입니다</span><span style="color: black;">. </span><span style="color: black;">또한 </span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>콩팥 기능이 저하된 경우</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>(</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>크레아티닌</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 청소율이 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>30ml/min </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>미만</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>:</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>정상의 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>30%) </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>사용을 중지</b></span><span style="color: black;">하여야 하기 때문에 이 약제 사용은 신중할 필요가 있습니다</span><span style="color: black;">.</span><br><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>2.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>메글리티나이드제</b></span><br><span style="color: black;">식사 전에 복용하며 식후 고혈당을 조절하는 약제로 </span><span style="color: black;">설폰요소제</span><span style="color: black;"> 보다는 상대적으로 </span><span style="color: black;">저혈당</span><span style="color: black;"> 발생의 위험도가 </span><span style="color: black;">낮지만 <span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>콩팥 기능이 저하된 경우</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>(</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>크레아티닌</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 청소율이 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>30ml/min </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>미만</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>:</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>정상의 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>30%) </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>사용을 중지</b></span> 해야 합니다.</span><br><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>3.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b> </b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>비구아나이드계</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>(</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>메트포르민</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>)</b></span><br><span style="color: black;">가장 큰 장점은 인슐린 분비를 자극하기 않기 때문에 혈당이 감소해도</span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>저혈당</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 발생이 거의 없습니다</b></span><span style="color: black;">. </span><span style="color: black;">다만 비타민 </span><span style="color: black;">B12</span><span style="color: black;">와 </span><span style="color: black;">엽산의</span><span style="color: black;"> 흡수 장애를 유발할 수 있어 </span><span style="color: black;"></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>위축성</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 위염 및 비타민 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>B12</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>결핍환자에서는 주의가</b></span><span style="color: black;"> 필요합니다</span><span style="color: black;">. </span><span style="color: black;">노인 분들에게 가장 불편한 </span><span style="color: black;"></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>위장관 장애의 부작용이 있고 이 약제의 효과인 체중 감소는 약한 환자에게는 오히려 독</b></span><span style="color: black;">이 될 수 </span><span style="color: black;">잇어</span><span style="color: black;"> 조심해야 합니다</span><span style="color: black;">. </span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>80</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>세 이상의 노인에게는 새로 추가하지 않아야 하고</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, 70</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>세 이상에서는 신장 기능에 대한 주기적인 검사</b></span><span style="color: black;">가 필요합니다</span><span style="color: black;">.<br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><span style="color: black;"><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>4.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b> </b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>티아졸리딘디온제</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>(</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>글리타존</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>)</b></span></span></span><span style="color: black;"><br><span style="color: black;">하루 한 번의 간편한 복용과 </span><span style="color: black;">저혈당이</span><span style="color: black;"> 발생하지 않는 등의 장점으로 </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>노인 당뇨병환자에서 사용하기 좋은 약제</b></span></span><span style="color: black;"><span style="color: black;">입니다</span><span style="color: black;">. </span><span style="color: black;">그러나 </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span style="color: black;"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>체중증가</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>심부전의 악화</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>심혈관질환과 관련된 안전성 여부</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>여성 환자에서 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>골밀도</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 감소와 함께 골절 위험도 증가</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>약제 가격의 부담 </b></span></span></span><span style="color: black;"><span style="color: black;">등이 노인 당뇨병환자에서 제약이 되므로 이러한 사항들을 충분히 고려한 후 선택해야 합니다</span><span style="color: black;">.</span><br><span style="color: black;"></span></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>5.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>알파글루코시다아제</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b> </b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>억제제</b></span></span><span style="color: black;"><br><span style="color: black;">노인 당뇨병환자는 식후혈당 조절이 어려운 경우가 </span><span style="color: black;">많습니다</span><span style="color: black;">. </span><span style="color: black;">그러므로 탄수화물의 흡수 지연에 의한 식후 혈당 조절효과를 가지는 이 약제가 혈당 조절에 도움이 될 수 </span><span style="color: black;">있습니다</span><span style="color: black;">. </span><span style="color: black;">하지만</span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 위장관 증상이 나타나고 자주 복용</b></span></span><span style="color: black;"><span style="color: black;">해야 하며 상대적으로 고가인 점이 걸림돌이 </span><span style="color: black;">됩니다</span><span style="color: black;">.</span><br><span style="color: black;"></span></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>6.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>DPP-4</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>억제제</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>(</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>글립틴</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>)</b></span></span><span style="color: black;"><br><span style="color: black;">저혈당</span><span style="color: black;"> 발생이 드물고 체중 증가는 나타나지 않으며 감염 및 위장관 부작용에 있어서도 다른 약제에 비해 발생 빈도가 낮은 것으로 보고되어 </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>노인 당뇨병환자에 좋은 치료제</b></span></span><span style="color: black;"><span style="color: black;">로 고려될 수 </span><span style="color: black;">있습니다</span><span style="color: black;">.</span><br><span style="color: black;"></span></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>7.SGLT-2 </b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>억제제</b></span></span><span style="color: black;"><br><span style="color: black;">저혈당의</span><span style="color: black;"> 위험도가 낮다는 점에서는 노인환자에서 유용한 약제이지만 여성 당뇨병환자에서 비뇨기 또는 요로감염의 감염도가 높은 </span><span style="color: black;">약제입니다</span><span style="color: black;">. </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span style="color: black;"><span style="color: black;"></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>체액 저하에 대한 부작용을 고려해야 하며</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>, </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>심부전 환자에서도 사용을 주의하는 </b></span></span></span><span style="color: black;"><span style="color: black;">것이 </span><span style="color: black;">좋습니다</span><span style="color: black;">.</span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span style="color: black;"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>75</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>세 이상의 고려의 환자에서는 사용하지 않습니다</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>.</b></span></span></span><span style="color: black;"><br><span style="color: black;"></span></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b></b><br></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>8.</b></span><span class="se_fs_T2" style="color: rgb(0, 175, 239);"><b>인슐린</b></span></span><span style="color: black;"><br><span style="color: black;">노인 당뇨병환자에서의 인슐린 주사 방법으로는 기존의 경구 약제를 일부 유지한 상태에서 </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>지속형 인슐린을 먼저 추가</b></span></span><span style="color: black;"><span style="color: black;">하고</span><span style="color: black;">, </span><span style="color: black;">필요에 따라 </span></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><span style="color: black;"><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>식전 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>속효성</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b> 인슐린 주사를 </b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>1</b></span><span class="se_fs_T2" style="color: rgb(241, 47, 34);"><b>회 추가</b></span></span></span><span style="color: black;"><span style="color: black;">로 투여하는 방법을 사용하는 것이 </span><span style="color: black;">좋습니다</span><span style="color: black;">.</span><br></span></p></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"><p class="se_textarea"></p></div></div></div></div></div></div><div class="se_component se_sticker default "><div class="se_sectionArea se_align-center"><div class="se_editArea"><div class="se_viewArea"><div class="se_sticker_area" id="SEDOC-1527144790849-1990419019_sticker_1" style="text-align: center;"><a class="se_mediaArea __se_sticker_link __se_link" 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106;"></div></div></div><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 0px; top: 0px; width: 100%; height: 100%; overflow: visible; display: none; position: absolute; z-index: 10000; opacity: 0.5; background-color: rgb(255, 255, 255); -webkit-tap-highlight-color: rgba(0, 0, 0, 0);"></div></div></div><div style="margin: 0px; padding: 0px; right: 0px; bottom: 0px; position: absolute; z-index: 100; pointer-events: none;"><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; height: 21px; float: right; pointer-events: none;"><div style="margin: 0px 12px 7px 2px; width: 52px; height: 14px; overflow: hidden; position: relative; pointer-events: auto;"><span style='margin: 0px; padding: 0px 4px; text-align: center; line-height: 11px; font-family: Helvetica,AppleSDGothicNeo-Light,nanumgothic,NanumGothic,"나눔고딕",Dotum,"돋움",sans-serif; font-size: 10px; font-weight: bold; display: block; text-shadow: -1px 0px rgba(255,255,255,0.3), 0px 1px rgba(255,255,255,0.3), 1px 0px rgba(255,255,255,0.3), 0px -1px rgba(255,255,255,0.3);'>50m</span><img width="44" height="4" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 4px; width: 44px; height: 4px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fmantle%2F1x%2Fscale-normal-b.png"><img width="4" height="10" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 0px; width: 4px; height: 10px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fmantle%2F1x%2Fscale-normal-l.png"><img width="4" height="10" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; width: 4px; height: 10px; right: 0px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fmantle%2F1x%2Fscale-normal-r.png"></div></div></div><div style="margin: 0px; padding: 0px; left: 0px; bottom: 0px; position: absolute; z-index: 100; pointer-events: none;"><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; height: 21px; float: left; pointer-events: none;"><div class="map_copyright" style='margin: 0px; padding: 0px 0px 2px 10px; height: 19px; color: rgb(68, 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